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目的探讨血管内超声在不稳定心绞痛患者进行介入手术时的应用价值。方法选择52例需行介入治疗的不稳定心绞痛患者,随机分为经血管内超声指导的介入治疗组和经常规冠状动脉造影指导的介入治疗组。观察两组患者手术成功率、选择支架的直径及个数、支架扩张时最大球囊压力、管腔直径的急性获得值、支架植入后残余狭窄、最小管腔直径,并对两组患者进行了12个月的随访,观察死亡、Q波心肌梗死、因不稳定心绞痛再次住院、亚急性血栓闭塞等情况。结果经血管内超声指导组患者达到满意的介入效果,球囊压力、管腔直径的急性获得值及最小管腔直径明显高于常规治疗组[分别为(1491.77±197.96)kPa对(1317.04±180.79)kPa,P<0.01;(2.25±0.38)mm对(2.02±0.34)mm,P<0.05;(2.98±0.38)mm对(2.69±0.37)mm,P<0.01];术后靶病变血管残余狭窄率、术后12个月内因不稳定心绞痛住院率明显低于常规治疗组[分别为(4.42±6.05)%对(8.65±8.43)%,P<0.05;3.85%对23.07%,P<0.05]。结论对不稳定性心绞痛患者进行介入手术时,血管内超声指导比冠状动脉造影指导的可操作性和远期效果均好;支架内球囊压力大于1519.87kPa(15大气压)时,介入治疗效果较佳。
Objective To investigate the value of intravascular ultrasound in the interventional treatment of unstable angina pectoris patients. Methods Fifty-two patients with unstable angina who underwent interventional therapy were randomly divided into interventional therapy group guided by intravascular ultrasound and interventional therapy group guided by conventional coronary angiography. The success rate of surgery, the diameter and number of scaffolds selected, the maximum balloon pressure during scaffold dilatation, the acute acquisition of luminal diameter, the residual stenosis after stent implantation and the minimum luminal diameter were observed. The two groups of patients After a 12-month follow-up, we observed the death, Q wave myocardial infarction, hospitalization for unstable angina, subacute thromboembolism and so on. Results The patients who received intravascular ultrasound guided group achieved satisfactory interventional effect. The balloon pressure, lumen diameter and lumen diameter were significantly higher than those of the conventional treatment group [(1491.77 ± 197.96) kPa vs (1317.04 ± 180.79 (2.25 ± 0.38) mm vs (2.02 ± 0.34) mm, P <0.05; (2.98 ± 0.38) mm vs (2.69 ± 0.37) mm, P <0.01] (4.42 ± 6.05)% vs (8.65 ± 8.43)%, P <0.05; 3.85% vs 23.07% respectively, P <0.05 (P <0.05), and the rate of hospitalization for unstable angina within 12 months after operation was significantly lower than that of the control group ]. Conclusion In the interventional treatment of patients with unstable angina, the guidance of intravascular ultrasound is better than the guidance of coronary angiography and the long-term effect is good. When the intra-stent balloon pressure is more than 1519.87kPa (15 atm), the interventional effect is better good.