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  本文選題：血管內(nèi)超聲 + 冠狀動脈左主干病變�。� 參考：《皖南醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:本研究評估IVUS指導(dǎo)對冠狀動脈左主干病變患者經(jīng)皮冠狀動脈介入治療(PCI)臨床預(yù)后的影響。評估IVUS對含有“易損斑塊”的左主干病變患者PCI術(shù)后的影響。方法:入選我院2012年01月-2016年01月共76例冠狀動脈左主干病變并接受PCI治療的患者。分為兩組:1.IVUS組:29例冠狀動脈左主干病變患者行PCI治療,術(shù)中使用IVUS指導(dǎo);2.造影組:47例冠狀動脈左主干病變患者行PCI治療,使用常規(guī)造影指導(dǎo)。通過虛擬組織學(xué)超聲(VH-IVUS)識別的易損斑塊又將IVUS組患者又分為兩亞組:“易損斑塊組(12例)”和“非易損斑塊組(17例)”。隨訪的主要終點事件為主要心血管不良事件(MACE),包括:心源性死亡、心肌梗死和靶血管血運重建。比較IVUS組和冠脈造影組患者1年的主要終點事件發(fā)生率以及兩亞組患者1年的主要終點事件發(fā)生率。結(jié)果:IVUS組患者與冠脈造影組相比術(shù)后1年的MACE事件發(fā)生率有降低趨勢(6.9%versus 19.1%,log-rank P=0.072)。IVUS組術(shù)后1年的死亡率較冠脈造影組有降低趨勢(0.0%versus 8.5%,log-rank P=0.080)。IVUS指導(dǎo)與冠脈造影指導(dǎo)相比不能降低患者術(shù)后心肌梗死和靶血管血運重建的發(fā)生率(0.0%versus 2.1%,log-rank P=0.355;6.9%versus 10.6%,log-rank P=0.349)。易損斑塊組和非易損斑塊組術(shù)后1年的MACE事件發(fā)生率相似(8.3%versus 5.9%,log-rank P=0.702)。結(jié)論:IVUS指導(dǎo)與冠脈造影指導(dǎo)相比有減少左主干病變患者PCI術(shù)后1年的MACE事件發(fā)生率的趨勢。IVUS指導(dǎo)可能通過降低術(shù)后死亡率來優(yōu)化預(yù)后,值得臨床推廣。與非易損斑塊組相比,IVUS指導(dǎo)未增加易損斑塊組患者PCI術(shù)后1年MACE事件的發(fā)生風(fēng)險。
[Abstract]:Objective: to evaluate the effect of IVUS guidance on the prognosis of patients with left coronary artery disease after percutaneous coronary intervention (PCI). To evaluate the effect of IVUS on left main lesion with vulnerable plaque after PCI. Methods: from January 2012 to January 2016, 76 patients with left main coronary artery disease treated with PCI were enrolled. In IVUS group, 29 patients with left main coronary artery disease were treated with PCI, and 2 patients were treated with IVUS during operation. 2. In contrast group, 47 patients with left main coronary artery disease were treated with PCI and guided by conventional angiography. The vulnerable plaques identified by VH-IVUSwere subdivided into two subgroups: "vulnerable plaque group (n = 12)" and "non-vulnerable plaque group (n = 17)". The main endpoint events were major cardiovascular adverse events, including cardiac death, myocardial infarction and target vessel revascularization. The incidence of major end point events in IVUS group and coronary angiography group was compared with that in two subgroups. Results compared with the coronary angiography group, the incidence of MACE events in the first year of coronary angiography in the% IVUS group was lower than that in the coronary angiography group (6.9% vs 19.1log-rank P=0.072).IVUS). The mortality rate in the P=0.072).IVUS group was lower than that in the coronary angiography group (0.0versus 8.5%). The P=0.080).IVUS guidance could not be decreased compared with the coronary angiography group. The incidence of myocardial infarction and target vessel revascularization was 0.0versus 2.1, and log-rank P was 0.3556.9and log-rank P was 0.349. The incidence of MACE events in vulnerable plaque group and non-vulnerable plaque group was similar to that in vulnerable plaque group (8.3versus 5.9) and non-vulnerable plaque group (P < 0.702). Conclusion compared with coronary arteriography, the MACE events in patients with left main lesion after 1 year after PCI may be improved by reducing the mortality rate, which is worthy to be popularized in clinical practice. [conclusion] compared with coronary angiographic guidance, there is a tendency to reduce the incidence of MACE events in patients with left main lesion one year after operation. Compared with non-vulnerable plaque group, IVUS guidance did not increase the risk of MACE events 1 year after PCI in vulnerable plaque group.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541.4

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1 陳偉偉;高潤霖;劉力生;朱曼璐;王文;王擁軍;吳兆蘇;李惠君;顧東風(fēng);楊躍進;鄭哲;蔣立新;胡盛壽;;《中國心血管病報告2015》概要[J];中國循環(huán)雜志;2016年06期

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