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目的:比较冠脉真性分叉病变在进行主支支架植入术时,边支球囊潜埋与边支导丝保护2种方法对边支的保护效果。方法:44例冠脉真分叉病变患者,随机分为球囊潜埋组(20例)和导丝保护组(24例)。比较两组边支开口受累及率、边支开口严重累及率、边支丢失率、导丝交换时间、完成导丝交换所接受X线暴露量及造影剂用量、术后血清高敏肌钙蛋白T(TNT-h)升高率、术后缺血性胸痛发生率。结果:两组边支开口受累及率、边支丢失率、术后缺血性胸痛发生率差异无统计学意义;两组边支开口严重累及率、导丝交换时间、X线暴露量、造影剂用量、术后血清TNT-h升高率差异有统计学意义(P<0.05);术后随访8~12个月,两组术后主要心血管不良事件的发生率差异无统计学意义。结论:在真性分叉病变介入治疗中,边支球囊潜埋技术较导丝保护技术可以明显减轻因斑块变形、移位造成的边支开口受累及的严重程度,保证交换导丝顺利,缩短手术时间,减少X线暴露量,减少造影剂用量,减少心肌损伤,且不增加术后主要心血管不良事件的发生率。
OBJECTIVE: To compare the protective effects of two methods on the marginal branch in the case of coronary bifurcation lesion under the main stent implantation. Methods: Forty-four patients with coronary bifurcation lesions were randomly divided into balloon-burial group (20 cases) and guide wire protection group (24 cases). The involvement rates of the side branches, the serious involvement rate of the branches and branches, the loss rate of the branches and the exchange of the guide wire were compared between the two groups. The X-ray exposure and the amount of the contrast agent were fulfilled in the guidewire exchange. The postoperative serum levels of high-sensitivity troponin T (TNT-h) rate of increase, postoperative ischemic chest pain incidence. Results: There was no significant difference in the rate of involvement of lateral branches, the loss of marginal branches and the incidence of postoperative ischemic chest pain in both groups. The incidence of serious involvement of lateral branches, the time of guidewire exchange, the amount of X-ray exposure, Dose and postoperative serum TNT-h increased significantly (P <0.05). There was no significant difference in the incidence of major adverse cardiovascular events between the two groups after 8 to 12 months of follow-up. Conclusion: In the bifurcation of true bifurcation lesions, the technique of burying the lateral branch balloon can significantly reduce the degree of involvement of the side branches caused by plaque deformation and displacement, and ensure the smooth exchange of the guide wire. Shorten the operation time, reduce the X-ray exposure, reduce the amount of contrast agent, reduce myocardial injury, and do not increase the incidence of postoperative major adverse cardiovascular events.