本文選題：藥物洗脫支架 + 過度后擴�。� 參考：《浙江大學》2017年碩士論文

【摘要】：背景在對某些冠狀動脈長病變和分叉病變進行介入治療時,術者會使用超過支架設計直徑的球囊對支架近段進行后擴,即支架的過度后擴。過度后擴應用于藥物洗脫支架,可能會改變支架的空間構型,降低支架對病變部位的支撐力度,同時可能損傷藥物涂層,影響局部藥物濃度,從而對患者的預后產生不良影響。本研究試圖評估藥物洗脫支架過度后擴對冠心病患者主要不良心血管事件(MACE)發(fā)生率的影響。方法本研究選取2013年7月至2016年6月在浙江大學醫(yī)學院附屬邵逸夫醫(yī)院心內科住院治療、植入藥物洗脫支架、具有完整隨訪信息的1522名冠心病患者(2514個病變)作為研究對象,排除了既往接受過PCI或CABG以及分叉病變采用雙支架技術處理的患者。根據支架是否過度后擴,將研究對象分為過度后擴組(n=624)與非過度后擴組(n=898),比較兩組在MACE(死亡、非致死性心肌梗死和靶血管血運重建)發(fā)生率上是否存在顯著差異。結果兩組在性別、年齡、體重指數(body mass index,BMI)、吸煙、高血壓、糖尿病、高脂血癥、既往心肌梗死、既往卒中、冠心病家族史、臨床表現、術前LDL膽固醇、肌酐、空腹血糖等指標上無顯著差異。過度后擴組支架個數、支架長度、病變個數、處理的血管數多于非過度后擴組,差異有統(tǒng)計學意義。過度后擴組和非過度后擴組病變所在血管、B2或C型病變的比例(92.6%vs.90.5%,P=0.062)均無顯著差異。兩組的死亡(2.1%vs.1.8%,P=0.706)、非致死性心肌梗死(4.0%vs.3.1%,P=0.394)、靶病變血運重建(5.3%vs.4.7%,P=0.631)均無顯著差異。結論藥物洗脫支架過度后擴不會對患者的預后產生顯著影響。
[Abstract]:Background in the interventional treatment of some long and branched coronary artery lesions, the balloon larger than the designed diameter of the stent is used to carry out the posterior expansion of the proximal segment of the stent, that is, the excessive posterior expansion of the stent. The application of excessive posterior expansion in drug-eluting stents may change the space configuration of the stents, reduce the support strength of the stents to the diseased sites, at the same time, it may damage the drug coating and influence the local drug concentration, which will have a negative impact on the prognosis of the patients. The aim of this study was to evaluate the effect of drug-eluting stent overexpansion on the incidence of major adverse cardiovascular events (MACEs) in patients with coronary heart disease (CHD). Methods from July 2013 to June 2016, 1522 patients with coronary heart disease (2514 lesions) who were hospitalized in Department of Cardiology, affiliated to run run Shaw Hospital, Zhejiang University Medical College, were implanted with drug-eluting stents. Patients who had previously been treated with PCI or CABG and bifurcation were excluded. According to whether the stent was overexpanded or not, the subjects were divided into two groups: hyperdilation group (n = 624) and non-hyperdilated group (n = 898N). There were significant differences in the incidence of MACE (death, non-fatal myocardial infarction and target vessel revascularization) between the two groups. Results there were two groups: sex, age, body mass index, smoking, hypertension, diabetes, hyperlipidemia, myocardial infarction, stroke, family history of coronary heart disease, clinical manifestation, preoperative LDL cholesterol, creatinine. There was no significant difference in fasting blood glucose and other indexes. The number of stents, the length of stent, the number of lesions and the number of blood vessels treated were more than those of non-overexpansion group, the difference was statistically significant. There was no significant difference in the proportion of type B 2 or type C lesions between the patients with excessive posterior expansion and those with non-excessive posterior expansion. There was no significant difference between the two groups (vs.90.5 P0.062). There was no significant difference between the two groups in terms of blood vessel revascularization (5.3vs.4.7), non-fatal myocardial infarction (4.0vs.3.1P 0.394) and target lesion revascularization (5.3vs.4.7). Conclusion excessive expansion of drug-eluting stents does not significantly affect the prognosis of patients.
【學位授予單位】：浙江大學
【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：1834481