發(fā)布時間：2018-01-06 21:18

  本文關鍵詞：紫杉醇藥物涂層球囊用于治療支架內(nèi)再狹窄的臨床研究　出處：《大連醫(yī)科大學》2017年碩士論文　論文類型：學位論文

  更多相關文章： 支架內(nèi)再狹窄 藥物涂層球囊 經(jīng)皮冠狀動脈治療

【摘要】：目的:研究紫杉醇藥物涂層球囊在治療冠狀動脈支架植入術后出現(xiàn)的支架內(nèi)再狹窄病變中的有效性及安全性。方法:研究分析了 2015年05月至2015年12月期間就診于遼寧省人民醫(yī)院,經(jīng)冠狀動脈造影檢查提示支架內(nèi)再狹窄的患者33例,均采用紫杉醇藥物涂層球囊(SeQuent Please)來處理再狹窄處病變,并于術后9-12個月進行冠狀動脈造影檢查。收集患者術前、術后、造影復查時的血管狹窄程度和最小內(nèi)徑等資料,應用SPSS 17.0統(tǒng)計軟件對數(shù)據(jù)進行統(tǒng)計分析,觀察患者應用藥物涂層球囊治療支架內(nèi)再狹窄的介入治療成功率、手術獲益情況、病變節(jié)段內(nèi)晚期管腔丟失情況、再狹窄復發(fā)率及心血管不良事件發(fā)生率等。結(jié)果:本研究所選取的33名患者在行普通球囊預擴張時的過程均順利,未出現(xiàn)影響血流的夾層,并順利應用紫杉醇藥物涂層球囊對支架內(nèi)再狹窄病變進行了治療,所有病變藥物球囊擴張時間持續(xù)49±3s,介入手術的即刻成功率為100%,住院期間無心血管不良事件發(fā)生。所有患者術后均給予了 3個月的雙聯(lián)抗血小板治療,術后1、3、6個月臨床隨訪無心絞痛再發(fā)、無其他心血管不良事件的發(fā)生。1名71歲男性患者在術后5個月時因為確診肺部腫瘤,拒絕行冠狀動脈造影檢查。在術后9-12個月,共有32人參加了造影復查,造影隨訪率為97%(32/33),在參與冠狀動脈造影復查的32名患者中,1名42歲男性患者在術后10個月時出現(xiàn)心絞痛癥狀,于我院復查造影,發(fā)現(xiàn)支架內(nèi)復發(fā)再狹窄,最重狹窄90%,給予植入DES治療,并更換抗血小板藥(氯吡格雷改為替格瑞洛),之后未再發(fā)心絞痛癥狀。其余31名患者造影復查顯示支架內(nèi)未見明顯再狹窄,也未再發(fā)心絞痛癥狀。術前后病變狹窄程度比較,患者術后與術前的病變狹窄程度有統(tǒng)計學差異[11.0±5.4%vs.77.6±8.9%,p0.05],患者造影復查時與術前的病變狹窄程度有統(tǒng)計學差異[12.9±4.9%vs.77.6±8.99%,P0.05],患者造影復查時與術后的病變狹窄程度無統(tǒng)計學意義[12.9 ± 4.9%vs.10.6 ±5.4%,P=0.173],應用藥物涂層球囊治療支架內(nèi)再狹窄病變的手術即刻成功率為 100%。術前后病變最小內(nèi)徑比較,患者術后與術前的病變最小內(nèi)徑有統(tǒng)計學差異[3.02±0.40mmvs.0.69±0.25mm,p0.05],患者造影復查時與術前的病變最小內(nèi)徑有統(tǒng)計學差異[2.95±0.40mm vs.0.69±0.25mm,P0.05],患者造影復查時與術后的最小內(nèi)徑無統(tǒng)計學差異[2.95±0.40mm vs.3.02±0.40mm,P=0.173],應用藥物涂層球囊治療支架內(nèi)再狹窄病變的手術即刻獲益為 2.33 ±0.34mm。應用藥物涂層球囊治療支架內(nèi)再狹窄病變術后9-12個月的晚期管腔丟失為0.07±0.18mm,與文獻報道相一致。結(jié)論:1、應用紫杉醇藥物涂層球囊治療冠狀動脈支架內(nèi)再狹窄病變的圍術期安全有效,手術即刻成功率為100%,手術即刻獲益令人滿意,住院期間未發(fā)生心血管不良事件。2、臨床和造影隨訪:應用紫杉醇藥物涂層球囊治療冠狀動脈支架內(nèi)再狹窄病變的患者的術后9-12個月心絞痛復發(fā)率低,復發(fā)率為3.1%(1/32),且術后9-12個月復查冠狀動脈造影顯示病變節(jié)段晚期管腔丟失未見明顯增高。
[Abstract]:Objective: the efficacy and safety of paclitaxel eluting stent balloon in the treatment of coronary artery stent implantation appears in stentrestenosis. Methods: analysis of the 2015 05 to December 2015 during visits to the Liaoning Provincial People's Hospital, underwent coronary angiography and prompt stent restenosis in 33 patients. Using paclitaxel eluting balloon (SeQuent Please) to treat restenosis lesions and coronary artery angiography 9-12 months after surgery. Patients were collected before surgery, postoperative vascular stenosis by angiography and the minimum diameter data, using SPSS 17 statistical software for statistical data analysis, observation patients with drug coated balloon for treatment of in stent restenosis interventional treatment success rate, operation benefit, segmental lesions in late lumen loss, restenosis rate and cardiovascular adverse The event rate. Results: This study selected 33 patients with normal balloon dilation of smooth, does not appear to affect blood flow and dissection, successful application of paclitaxel eluting balloon in stent restenosis lesions were treated, all lesions drug balloon time for 49 + 3S, success rate immediate surgical intervention was 100%, no adverse cardiovascular events during hospitalization. All patients were given 3 months of dual antiplatelet therapy, postoperative 1,3,6 months follow-up angina recurrence, no other adverse cardiovascular events.1 71 year old male patients in 5 months after operation because the diagnosis of lung cancer, to undergo coronary angiography. In 9-12 months after operation, a total of 32 people participated in the angiography angiographic follow-up rate was 97% (32/33), in 32 patients in the coronary angiography was performed in 1 at the age of 42 Male patients after 10 months of surgery anginal symptoms in our hospital, the angiography, stent restenosis was found recurrence, the most narrow 90%, give the implantation of DES treatment, and the replacement of antiplatelet drugs (clopidogrel to ticagrelor), after no recurrence of angina symptoms. The remaining 31 patients with angiography show no significant in stent restenosis, no recurrence of angina symptoms. Preoperative and postoperative stenosis, patients with stenosis before operation there was significant difference between the [11.0 + 5.4%vs.77.6 + 8.9%, p0.05], angiography and the patients with stenosis before operation had statistical difference between [12.9 + 4.9%vs.77.6 + 8.99%. P0.05], patients with angiography and stenosis after surgery had no statistically significant [12.9 + 4.9%vs.10.6 + 5.4%, P=0.173], the success rate of operation lesions with drugeluting stent restenosis was 100%. Minimum diameter of lesions before and after operation, postoperative and preoperative lesion minimum diameter had statistical difference between [3.02 + 0.40mmvs.0.69 + 0.25mm, p0.05], angiography and preoperative patients with lesions of minimum diameter had statistical difference between [2.95 + 0.40mm vs.0.69 + 0.25mm, P0.05], angiography and follow-up patients after operation was no minimum diameter the difference of [2.95 + 0.40mm vs.3.02 + 0.40mm, P=0.173], benefit lesions with drugeluting stent restenosis operation for late lumen 9-12 months was 0.07 + 0.18mm 2.33 + 0.34mm. application lost drugeluting stent restenosis lesions after operation, consistent with the reported lesions. Conclusion: 1. Paclitaxel eluting balloon in the treatment of coronary artery in stent restenosis in perioperative period is safe and effective, the success rate of operation was 100%, satisfactory operation benefit, no hospitalization The occurrence of cardiovascular adverse events.2, clinical and angiographic follow-up: low recurrence 9-12 months angina rate of lesions with paclitaxel eluting balloon in the treatment of coronary artery in stent restenosis in patients after surgery, the recurrence rate was 3.1% (1/32), and postoperative 9-12 months after coronary angiography showed segmental lesions late lumen loss there is no significant increase.

【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R541.4
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本文編號：1389562