边支双导丝技术在分叉病变中的边支保护作用

发布时间：2019-05-31 19:06

【摘要】：目的:比较在处理冠脉分叉病变时,边支内预留双导丝与传统预留单导丝在完成主支支架入后对边支血管的保护作用。方法:入选2014年2月至2016年8月之间,于青岛市城阳人民医院心血管内科共完成182例分叉病变的介入治疗,总共对120例患者采用了必要性支架技术,因其边支闭塞的风险较高,给予边支导丝进行保护,随机分为两组:A组(60例)在边支放置单导丝;B组(60例)在边支中放置双导丝。两组患者使用必要性支架植入技术,在完成球囊预扩张,支架植入后,两组之间边支闭塞的发生率,边支开口狭窄发生率增加,完成交换导丝的时间,边支需植入支架数量,同时比较两组术后心肌肌钙蛋白T的变化。6?12个月随访冠状动脉造影,再次评估狭窄水平。结果:A组发生边支闭塞8例(13.3%),B组无边支闭塞,A组严重狭窄发生率为38.3%(23例),B组为8.3%(5例)。交换导丝时间A组(25.6±13.2)分钟,而B组为(14.3±10.2)分钟(P0.05)。A组25例患者边支予以植入支架,但B组仅4例植入(P0.05)。术后观察A组11例c Tn T升高,平均程度为(0.22±0.03)ng/ml,B组仅1例c Tn T达到0.13ng/ml(P0.05)。术后6?12个月随访,A组24例患者接受冠状动脉造影检查,B组有21例,A组术后即刻有3例边支完全闭塞,B组并无边支闭塞。A组术后立即出现边支狭窄程度平均为(65.32±13.45)%,随访为(42.23±15.43)%,B组术后即刻出现边支狭窄程度平均为(50.42±15.32)%,随访为(20.25±11.53)%,两组的差异具有统计学意义(P0.05)。结论:在分叉病变中,完成冠脉分叉病变的主支支架植入后,予以双导丝保护边支较传统的单导丝放入边支或者重要分支,可以显著减少边支丢失的发生率,防止分支开口狭窄明显增加。同时一旦出现边支严重受累后,可以保证导丝顺利交换,并且快速交换到位,缩短了手术进行时间,提高了手术的安全性,同时也减少了边支支架的植入数量,从而降低了手术费用。双导丝的保护比单导丝更有效地减少心肌损伤,可改善心脏功能,提高患者的生活质量。双导线保护边支血管可以减少长期冠脉狭窄严重程度。
[Abstract]:Objective: to compare the protective effect of double guide wire reserved in side branch and traditional reserved single guide wire on side branch vessel after main branch stent entry in the treatment of coronary bifurcation lesion. Methods: from February 2014 to August 2016, 182 patients with bifurcation lesions were treated with interventional therapy in the Department of Cardiovascular Medicine, Chengyang people's Hospital of Qingdao. A total of 120 patients were treated with necessary stent technique because of the high risk of side branch occlusion. The side branch guide wire was randomly divided into two groups: group A (60 cases) placed a single guide wire on the side branch; Group B (60 cases) placed double guide wires in the side branch. The patients in the two groups used the necessary stent implantation technique. After the balloon predilatation and stent implantation, the incidence of side branch occlusion, the incidence of side branch opening stenosis, the time to complete the exchange guide wire and the number of stents needed to be implanted in the side branch were increased. At the same time, the changes of cardiac troponin T were compared between the two groups. Coronary angiography was followed up for 12 months to evaluate the stenosis level again. Results: side branch occlusion occurred in 8 cases in group A (13.3%), B group). The incidence of severe stenosis in group A was 38.3% (8.3% in 23 cases of), B group). The time of exchange guide wire was (25.6 卤13.2) minutes in group A and (14.3 卤10.2) minutes in group B (P 0.05). 25 patients in group). A were treated with stent implantation, but only 4 patients in group B (P 0.05). After operation, c Tn T increased in 11 cases in group A, with an average degree of (0.22 卤0.03) ng/ml,B. Only 1 case in group A c Tn T reached 0.13ng/ml (P 0.05). 24 patients in group A were examined by coronary angiography, 21 patients in group B and 3 patients in group A were completely occlusive immediately after operation. There was no collateral occlusion in group B. the average degree of collateral stenosis in group A was (65.32 卤13.45)%, and the follow-up rate was (42.23 卤15.43)%. The average degree of collateral stenosis in group B was (50.42 卤15.32)%. The follow-up rate was (20.25 卤11.53)%, and the difference between the two groups was statistically significant (P 0.05). Conclusion: in bifurcation lesions, double guide wire protection of side branch or important branch can significantly reduce the incidence of side branch loss after the implantation of the main branch stent of coronary bifurcation lesion, which can protect the side branch with double guide wire and put the side branch or important branch into the side branch compared with the traditional single guide wire. Prevent a significant increase in branch opening stenosis. At the same time, once the side branch is seriously involved, the guide wire can be exchanged smoothly, and the guide wire can be exchanged quickly, which can shorten the operation time, improve the safety of the operation, and at the same time reduce the number of side branch stent implantation. As a result, the cost of surgery is reduced. The protection of double guide wire is more effective than single guide wire in reducing myocardial injury, improving cardiac function and improving the quality of life of patients. Double lead protection of collateral vessels can reduce the severity of long-term coronary stenosis.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R54

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