本文選題：慢性完全閉塞病變 + 冠狀動(dòng)脈�。� 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：背景與目的:冠狀動(dòng)脈疾病是導(dǎo)致左心室功能障礙的主要原因,慢性完全閉塞(Chronic total occlusion,CTO)病變?cè)诠跔顒?dòng)脈疾病占有一定比例,冠脈CTO病變可以導(dǎo)致心肌冬眠,部分心肌可以壞死形成瘢痕,導(dǎo)致左心功能障礙和左心室重構(gòu),與非CTO病變相比,冠脈CTO有更差的左心功能,更高的死亡率。左心功能作為評(píng)價(jià)冠脈CTO疾病輕重的一項(xiàng)重要指標(biāo),鮮有證據(jù)比較單支與雙支CTO病變對(duì)左心功能的影響程度。本文回顧性對(duì)單支與雙支CTO病變對(duì)左心功能的影響程度進(jìn)行比較,并比較雙支CTO病變中不同血管組合對(duì)左心功能的影響有無差異。方法:回顧性分析2014年1月至2016年12月吉林大學(xué)第二醫(yī)院心內(nèi)科1032例經(jīng)冠狀動(dòng)脈造影檢查提示CTO患者的造影資料,按照病變CTO相關(guān)血管數(shù)目分為單支CTO組和雙支CTO組,按照入選和排除標(biāo)準(zhǔn)篩選后,共有129患者符合標(biāo)準(zhǔn),其中單支CTO組82例,雙支CTO組47例,對(duì)兩組患者的基本信息和左心功能心臟彩超參數(shù)包括左心房?jī)?nèi)徑(LA)、左心室內(nèi)徑(LV)、左室射血分?jǐn)?shù)(LVEF)、左室舒張末期容積(LVEDV)、左室收縮末期容積(LVESV)進(jìn)行統(tǒng)計(jì)學(xué)差異比較。另外對(duì)雙支CTO組按病變血管位置分組,其中LAD+RCA組24例、LAD+LCX組8例、LCX+RCA組15例,進(jìn)一步分析各組之間患者基本信息及左心功能參數(shù)進(jìn)行統(tǒng)計(jì)學(xué)差異比較。結(jié)果:1.雙支CTO組較單支CTO組具有更差的左心功能參數(shù),具有更明顯擴(kuò)大的LV大小(53.19±6.69mm vs 50.46±6.56mm,p0.05);具有更低的LVEF(54.89±11.00%vs 61.13±9.70%,p0.05);更高的LVEDV(162.64±51.80ml vs 143.41±47.05ml,p0.05);更高的LVESV(75.70±43.60ml vs 59.11±36.73ml,p0.05)。2.另外在雙支CTO病變不同血管組合比較中,顯示:(1)LVEF:LAD+LCX組和LCX+RCA組均低于LAD+RCA組(48.63±9.02%vs 59.29±10.24%,P0.05)和(51.20±10.69%vs 59.29±10.24%,P0.05);(2)LVEDV:LCX+RCA組高于LAD+RCA組(183.20±44.47m L vs 144.13±50.73 m L,P0.05);(3)LVESV:LAD+LCX組和LCX+RCA組均高于LAD+RCA組(96.00±46.51m L vs 59.75±38.56 m L,P0.05)和(90.40±42.65 m L vs59.75±38.56 m L,P0.05)。結(jié)論:在CTO病變中雙支CTO病變較單支CTO病變對(duì)左心功能的影響程度更明顯,具有更差左心功能。在雙支CTO病變?nèi)M不同血管組合中,LAD+LCX組合和LCX+RCA組合較LAD+RCA組合具有更差左心功能,對(duì)左心功能的影響顯著組均合并LCX,提示在雙支CTO病變中當(dāng)存在LCX病變時(shí)可能會(huì)顯著影響左心功能。
[Abstract]:Background & AIM: coronary artery disease is the main cause of left ventricular dysfunction. Chronic complete occlusion total occlusion (CTO) is the major cause of coronary artery disease. Coronary artery CTO disease can lead to myocardial hibernation. Some of the myocardium can necrosis and form scar, leading to left ventricular dysfunction and left ventricular remodeling. Coronary CTO has worse left heart function and higher mortality compared with non CTO lesions. Left ventricular function is an important index to evaluate the severity of coronary CTO disease. There is little evidence to compare the influence of single and double vessel CTO on left ventricular function. The effects of single vessel and double vessel CTO on left ventricular function were retrospectively compared, and the effects of different vascular combinations on left ventricular function in double vessel CTO were compared. Methods: from January 2014 to December 2016, 1032 patients with CTO were analyzed retrospectively by coronary angiography in the Department of Cardiology, second Hospital of Jilin University. According to the number of diseased CTO related vessels, they were divided into two groups: single vessel CTO group and double vessel CTO group. According to the selection and exclusion criteria, a total of 129 patients met the criteria, including 82 cases in single branch CTO group and 47 cases in double branch CTO group. The basic information and echocardiographic parameters of left ventricular function, including left atrial diameter, left ventricular diameter and LVV, left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDVV) and left ventricular end-systolic volume (LVESVV) were compared between the two groups. In addition, double-vessel CTO group was divided into two groups according to the location of the diseased vessels, including 24 cases of LAD RCA group with lad LCX group, 8 cases with LCX RCA group (15 cases). The basic information of the patients and the parameters of left ventricular function were analyzed and compared statistically among the two groups. The result is 1: 1. The left ventricular function parameters of the double-branch CTO group were worse than that of the single-vessel CTO group, with significantly larger LV size 53.19 鹵6.69mm vs 50.46 鹵6.56mm 6.69mm, lower LVEF(54.89 鹵11.00%vs 61.13 鹵9.70ml / 0.05, higher LVEDV(162.64 鹵51.80ml vs 143.41 鹵47.05mlp0.05m and higher LVESV(75.70 鹵43.60ml vs 59.11 鹵36.73ml / p0.05. 鍙﹀鍦ㄥ弻鏀疌TO鐥呭彉涓嶅悓琛，

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