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目的 :探讨冠心病患者冠脉血流储备分数(fractional flow reserve,FFR)测值的影响因素及FFR指导支架置入的效果。方法:选择张家港市第一人民医院2012年2月—2015年1月住院的存在反复胸闷胸痛症状、发生急性心梗及既往曾行PCI术并复查冠脉造影的冠心病患者60例,记录年龄、性别、吸烟史,以及血低密度脂蛋白胆固醇(low-density lipoproteincholesterol,LDL-C)、总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)及血糖(blood glucose,BG)等一般资料;全部患者进行冠脉动脉造影,记录狭窄程度及长度,并行FFR测定。根据FFR测定值分为两组:FFR≥0.8组与FFR<0.8组,比较两组患者的一般资料,并分析上述因素与FFR之间的相关性。对FFR<0.8的患者行支架置入术,并测定支架置入术后FFR值,比较支架置入术前后FFR值。随访1年,记录两组患者的心因性再入院、再发心绞痛、再血管化治疗、心律失常、心力衰竭、急性心肌梗死发生情况。结果:160例患者均完成冠状动脉造影和FFR测定,FFR≥0.8组与FFR<0.8组的一般资料比较差异无统计学意义;两组患者的冠脉狭窄程度和狭窄长度存在显著差异(P均<0.001),并且FFR与冠脉狭窄程度和长度呈显著负相关(P均<0.001);2FFR<0.8组,支架置入前后FFR值差异有统计学意义(P<0.001),置入支架后的FFR值与FFR≥0.8组的FFR值相比无显著差异(P=0.085);3根据不同的狭窄程度分别统计左前降支、右冠状动脉、左回旋支的病变数及FFR值并进行比较,结果显示狭窄程度相同的不同血管所测得的FFR值无统计学差异(P均>0.05);4随访结果显示,FFR≥0.8组和FFR<0.8并置入支架组之间再发心绞痛、原有病变再血管化治疗、心律失常和心力衰竭的发生率比较均无显著差异(P均>0.05),两组均无急性心肌梗死的发生。结论:FFR测值与冠状动脉狭窄的程度和长度呈显著负相关;狭窄程度越重,狭窄病变越长,对冠状动脉血流的功能学影响越明显。FFR测定能够有效指导支架的置入。
Objective: To investigate the influencing factors of coronary blood flow fractional fractional reserve (FFR) and the effect of FFR stenting. Methods: The First People’s Hospital of Zhangjiagang City from February 2012 to January 2015 there were hospitalizations repeated chest pain, chest pain, acute myocardial infarction and previous PCI and coronary angiography in 60 cases of coronary heart disease, record age , Gender, smoking history, low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglyceride (TG) and blood glucose (BG) General information; All patients underwent coronary angiography, recording the degree and length of stenosis, parallel FFR measurement. According to FFR measurement, the patients were divided into two groups: FFR≥0.8 group and FFR <0.8 group. The general data of two groups of patients were compared, and the correlation between these factors and FFR was analyzed. The patients with FFR <0.8 were treated with stenting, and FFR values were measured after stenting. The FFR values were compared before and after stenting. Followed up for 1 year, the two groups of patients were recorded for rehospitalization of cardioembolism, recurrent angina, revascularization, arrhythmia, heart failure, and acute myocardial infarction. Results: All 160 patients underwent coronary angiography and FFR. There was no significant difference in general data between FFR≥0.8 group and FFR <0.8 group. There was significant difference between the two groups in the degree of coronary artery stenosis and stenosis length (P (P <0.001). There was a significant negative correlation between the FFR and the degree and length of coronary artery stenosis (all P <0.001). The FFR of 2FFR <0.8 group before and after stenting was significantly different (P <0.001) (P = 0.085) .3 According to the degree of stenosis, the number of lesion and FFR of left anterior descending coronary artery and left circumflex artery were calculated and compared respectively (P> 0.05) .4 The follow-up results showed that FFR≥0.8 group and FFR <0.8 and placed in the group of stent between the recurrence of angina pectoris, There was no significant difference in the incidence of revascularization, arrhythmia and heart failure (P> 0.05). There was no acute myocardial infarction in both groups. CONCLUSION: The FFR measurement has a significant negative correlation with the degree and length of coronary artery stenosis. The more severe the stenosis and the longer the stenosis, the more obvious the functional effect on coronary blood flow. FFR measurement can effectively guide the stent placement.