【摘要】：背景： 目前隨著PCI治療冠心病數(shù)量的增多，冠狀動(dòng)脈穿孔（CAP）的發(fā)生也隨之增多，CAP作為一種少見但嚴(yán)重的并發(fā)癥也越來越受到臨床介入醫(yī)生的重視。CAP受到很多因素的影響，但目前國(guó)內(nèi)研究多為散發(fā)病例報(bào)道，國(guó)外研究結(jié)果相互矛盾，治療手段缺乏統(tǒng)一標(biāo)準(zhǔn)。本研究通過回顧性分析方法，以期為冠狀動(dòng)脈穿孔的防治積累更多的理論支持。 目的： 探討PCI過程中冠狀動(dòng)脈穿孔的發(fā)病率、危險(xiǎn)因素和治療策略。 方法： 本研究回顧了吉林大學(xué)白求恩第一醫(yī)院心血管中心2011年1月到2015年1月住院接受PCI的11853例患者，其中男8356例，女3497例。發(fā)現(xiàn)冠狀動(dòng)脈穿孔病人41例，其中男25例，女16例。余下11812例中隨機(jī)抽取105例，作為正常對(duì)照組，對(duì)其進(jìn)行臨床回顧性分析，包括病人基本臨床資料、介入手術(shù)操作及治療策略相關(guān)資料。 結(jié)果： ①總發(fā)生率為0.35%，，死亡率4.88%。②單因素分析結(jié)果顯示：穿孔組與未穿孔組在年齡（P=0.007）、B2+C類病變（P＜0.001）、重度鈣化病變（P=0.005）、慢性完全閉塞病變（P＜0.001）、小血管病變（P=0.011）、多支血管病變（P=0.003）、前降支病變（P=0.023）間差異具有統(tǒng)計(jì)學(xué)意義（P＜0.05）。多元Logistic回歸分析顯示：年齡增加（OR1.05；95%CI1.002-1.101）、重度鈣化病變（OR3.08；95%CI1.252-7.558）、慢性完全閉塞病變（OR2.80；95%CI1.083-7.225）、前降支病變（OR2.56；95%CI1.098-5.946）是冠狀動(dòng)脈穿孔的獨(dú)立危險(xiǎn)影響因素。③冠狀動(dòng)脈穿孔多與球囊（43.90%）和導(dǎo)絲(41.46%)操作有關(guān)。④球囊低壓擴(kuò)張、栓塞、覆膜支架植入、心包穿刺引流、血液回輸和緊急外科手術(shù)是冠狀動(dòng)脈穿孔的有效治療方法。 結(jié)論： ①冠狀動(dòng)脈穿孔作為PCI并發(fā)癥發(fā)生率低。②穿孔組與未穿孔對(duì)照組在年齡、B2+C類病變、重度鈣化病變、慢性完全閉塞病變、小血管病變、多支血管病變、前降支病變組間差異具有統(tǒng)計(jì)學(xué)意義。③年齡增加、重度鈣化病變、慢性完全閉塞病變、前降支病變是冠狀動(dòng)脈穿孔的獨(dú)立危險(xiǎn)因素。④經(jīng)球囊低壓擴(kuò)張、栓塞、覆膜支架植入、心包引流、血液回輸?shù)戎委熀笃漕A(yù)后良好。
[Abstract]:Background:
At present, with the increase of the number of coronary heart disease (PCI), the incidence of coronary artery perforation (CAP) is also increasing. As a rare but serious complication, CAP is becoming more and more seriously affected by the attention of clinical interventional doctors. However, the domestic research is mostly reported in scattered cases, and the results of foreign research are contradictory and treatment. There is a lack of uniform standard. This study provides a more theoretical support for the prevention and treatment of coronary artery perforation through retrospective analysis.
Objective:
Objective to investigate the incidence, risk factors and treatment strategies of coronary artery perforation during PCI.
Method:
This study reviewed 11853 patients who were hospitalized in the cardiovascular center of Bethune First Hospital of Jilin University from January 2011 to January 2015, including 8356 males and 3497 females. 41 cases of coronary artery perforation were found in 25 men and 16 women. 105 of the remaining 11812 cases were randomly selected as the normal control group, and the clinical retrospective was reviewed. Analysis included basic clinical data, interventional operation and treatment strategy.
Result:
(1) the total incidence was 0.35%, and the single factor analysis of mortality 4.88%. showed that the difference in age (P=0.007), B2+C type lesion (P < 0.001), severe calcification (P=0.005), chronic complete occlusion (P < 0.001), small vascular disease (P=0.011), multiple vessel lesion (P=0.003), and anterior descending branch (P=0.023) in the perforation group and the non perforation group were in general. Study significance (P < 0.05). Multivariate Logistic regression analysis showed that age increased (OR1.05; 95%CI1.002-1.101), severe calcification (OR3.08; 95%CI1.252-7.558), chronic complete occlusion (OR2.80; 95%CI1.083-7.225), and anterior descending lesion (OR2.56; 95% CI1.098-5.946) were independent risk factors for coronary artery perforation. Multiple pulse perforation is related to the operation of balloon (43.90%) and guide wire (41.46%). 4. Balloon dilatation, embolism, stent implantation, pericardial drainage, blood transfusion and emergency surgery are effective methods for the treatment of coronary artery perforation.
Conclusion:
(1) the incidence of coronary artery perforation as a PCI complication was low. (2) the differences in age, B2+C, severe calcification, chronic complete occlusion, small vascular lesions, multiple vessel lesions, and anterior descending lesions were statistically significant in the group of perforation and non perforation. Anterior descending lesion is an independent risk factor for coronary artery perforation. (4) the prognosis is good after balloon dilatation, embolization, stent implantation, pericardial drainage and blood transfusion.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R541.4

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