【摘要】：目的通過(guò)分析急性冠脈綜合征患者冠狀動(dòng)脈造影(CAG)及血管內(nèi)超聲(IVUS)檢查數(shù)據(jù),探討血管內(nèi)超聲在定量分析冠狀動(dòng)脈臨界病變管腔狹窄率,斑塊性質(zhì),進(jìn)一步治療和評(píng)價(jià)經(jīng)皮冠狀動(dòng)脈介入(PCI)治療效果中作用。研究血管內(nèi)超聲(IVUS)在急性冠脈綜合征(ACS)臨界病變中的應(yīng)用價(jià)值。 材料與方法1)對(duì)2010年1月至2014年3月大同市三醫(yī)院心內(nèi)科32例根據(jù)臨床表現(xiàn)診斷為ACS患者,其中男21例(65.63%),女11例(34.37%),年齡32～73歲,平均年齡(58.1±10.4)歲,均行冠狀動(dòng)脈造影評(píng)估每一位患者左主干(LM)、左前降支(LAD)、左回旋支(LCX)、右冠狀動(dòng)脈(RCA)的管腔狹窄情況；2)冠狀動(dòng)脈造影發(fā)現(xiàn)的狹窄≥70%的病變直接行PCI,臨界病變血管段進(jìn)行IVUS檢測(cè),觀察血管壁的形態(tài)結(jié)構(gòu),分析動(dòng)脈粥樣硬化斑塊的類型、性質(zhì)及其狹窄程度,對(duì)符合PCI干預(yù)指征的病變行PCI術(shù),其余患者予藥物保守治療；3)PCI術(shù)后行IVUS檢查即刻評(píng)價(jià)支架置入是否理想、是否合并手術(shù)并發(fā)癥。 結(jié)果1)32例患者中CAG發(fā)現(xiàn)冠脈血管12支17處病變管腔直徑狹窄率≥70%,予直接行支架植入術(shù),共植入17枚支架；2)CAG測(cè)得38處管腔直徑狹窄率為50-70%(臨界病變),經(jīng)IVUS測(cè)得有33處病變管腔狹窄率≥70%,涉及28位患者,共置入33枚支架,單支架23例,雙支架5例；3)CAG與IVUS檢測(cè)的38處臨界病變處直徑狹窄率及管腔面積狹窄率(斑塊負(fù)荷)比較,IVUS測(cè)值顯著高于CAG測(cè)值,統(tǒng)計(jì)學(xué)上有顯著性差異(P0.01)；4)術(shù)后行IVUS檢查示均顯示支架完全貼壁、擴(kuò)張充分、展開(kāi)均勻、完全覆蓋病變,未發(fā)現(xiàn)冠脈內(nèi)夾層形成、壁內(nèi)血腫、支架斷裂等PCI術(shù)后并發(fā)癥；5)另外5處病變涉及4例患者因行IVUS檢查結(jié)果未達(dá)支架植入標(biāo)準(zhǔn),予藥物治療。 結(jié)論1)CAG不同程度地低估了冠狀動(dòng)脈臨界病變狹窄,IVUS與CAG相比發(fā)現(xiàn)的臨界病變管腔狹窄率診斷更精確。2)IVUS對(duì)斑塊定性較CAG更優(yōu)。3)更能準(zhǔn)確選擇臨界病變支架置入的適應(yīng)證。4)IVUS能進(jìn)一步明確冠狀動(dòng)脈臨界病變的性質(zhì)和狹窄程度并能指導(dǎo)臨床治療,安全性高,在冠心病介入治療中發(fā)揮重要作用。
[Abstract]:Objective to study the quantitative analysis of coronary artery stenosis rate and plaque character in patients with acute coronary syndrome by coronary angiography (CAG) and intravascular ultrasound (IVUS). Further treatment and evaluation of percutaneous coronary intervention (PCI) effect. To study the application value of intravascular ultrasound (IVUS) in critical lesions of (ACS) in acute coronary syndrome (ACS). Materials and methods 1) from January 2010 to March 2014, 32 patients with ACS were diagnosed in Department of Cardiology, three Hospitals of Datong City, including 21 males (65.63%) and 11 females (34.37%), aged 32 to 73 years. The mean age was (58.1 鹵10.4) years. Coronary angiography was performed to evaluate the stenosis of left anterior descending (LAD), left circumflex (LAD), (LCX), right coronary (RCA) in each patient. 2) the stenosis 鈮，

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