【摘要】：目的:比較在處理冠脈分叉病變時,邊支內(nèi)預(yù)留雙導(dǎo)絲與傳統(tǒng)預(yù)留單導(dǎo)絲在完成主支支架入后對邊支血管的保護(hù)作用。方法:入選2014年2月至2016年8月之間,于青島市城陽人民醫(yī)院心血管內(nèi)科共完成182例分叉病變的介入治療,總共對120例患者采用了必要性支架技術(shù),因其邊支閉塞的風(fēng)險較高,給予邊支導(dǎo)絲進(jìn)行保護(hù),隨機(jī)分為兩組:A組(60例)在邊支放置單導(dǎo)絲;B組(60例)在邊支中放置雙導(dǎo)絲。兩組患者使用必要性支架植入技術(shù),在完成球囊預(yù)擴(kuò)張,支架植入后,兩組之間邊支閉塞的發(fā)生率,邊支開口狹窄發(fā)生率增加,完成交換導(dǎo)絲的時間,邊支需植入支架數(shù)量,同時比較兩組術(shù)后心肌肌鈣蛋白T的變化。6?12個月隨訪冠狀動脈造影,再次評估狹窄水平。結(jié)果:A組發(fā)生邊支閉塞8例(13.3%),B組無邊支閉塞,A組嚴(yán)重狹窄發(fā)生率為38.3%(23例),B組為8.3%(5例)。交換導(dǎo)絲時間A組(25.6±13.2)分鐘,而B組為(14.3±10.2)分鐘(P0.05)。A組25例患者邊支予以植入支架,但B組僅4例植入(P0.05)。術(shù)后觀察A組11例c Tn T升高,平均程度為(0.22±0.03)ng/ml,B組僅1例c Tn T達(dá)到0.13ng/ml(P0.05)。術(shù)后6?12個月隨訪,A組24例患者接受冠狀動脈造影檢查,B組有21例,A組術(shù)后即刻有3例邊支完全閉塞,B組并無邊支閉塞。A組術(shù)后立即出現(xiàn)邊支狹窄程度平均為(65.32±13.45)%,隨訪為(42.23±15.43)%,B組術(shù)后即刻出現(xiàn)邊支狹窄程度平均為(50.42±15.32)%,隨訪為(20.25±11.53)%,兩組的差異具有統(tǒng)計學(xué)意義(P0.05)。結(jié)論:在分叉病變中,完成冠脈分叉病變的主支支架植入后,予以雙導(dǎo)絲保護(hù)邊支較傳統(tǒng)的單導(dǎo)絲放入邊支或者重要分支,可以顯著減少邊支丟失的發(fā)生率,防止分支開口狹窄明顯增加。同時一旦出現(xiàn)邊支嚴(yán)重受累后,可以保證導(dǎo)絲順利交換,并且快速交換到位,縮短了手術(shù)進(jìn)行時間,提高了手術(shù)的安全性,同時也減少了邊支支架的植入數(shù)量,從而降低了手術(shù)費用。雙導(dǎo)絲的保護(hù)比單導(dǎo)絲更有效地減少心肌損傷,可改善心臟功能,提高患者的生活質(zhì)量。雙導(dǎo)線保護(hù)邊支血管可以減少長期冠脈狹窄嚴(yán)重程度。
[Abstract]:Objective: to compare the protective effect of double guide wire reserved in side branch and traditional reserved single guide wire on side branch vessel after main branch stent entry in the treatment of coronary bifurcation lesion. Methods: from February 2014 to August 2016, 182 patients with bifurcation lesions were treated with interventional therapy in the Department of Cardiovascular Medicine, Chengyang people's Hospital of Qingdao. A total of 120 patients were treated with necessary stent technique because of the high risk of side branch occlusion. The side branch guide wire was randomly divided into two groups: group A (60 cases) placed a single guide wire on the side branch; Group B (60 cases) placed double guide wires in the side branch. The patients in the two groups used the necessary stent implantation technique. After the balloon predilatation and stent implantation, the incidence of side branch occlusion, the incidence of side branch opening stenosis, the time to complete the exchange guide wire and the number of stents needed to be implanted in the side branch were increased. At the same time, the changes of cardiac troponin T were compared between the two groups. Coronary angiography was followed up for 12 months to evaluate the stenosis level again. Results: side branch occlusion occurred in 8 cases in group A (13.3%), B group). The incidence of severe stenosis in group A was 38.3% (8.3% in 23 cases of), B group). The time of exchange guide wire was (25.6 鹵13.2) minutes in group A and (14.3 鹵10.2) minutes in group B (P 0.05). 25 patients in group). A were treated with stent implantation, but only 4 patients in group B (P 0.05). After operation, c Tn T increased in 11 cases in group A, with an average degree of (0.22 鹵0.03) ng/ml,B. Only 1 case in group A c Tn T reached 0.13ng/ml (P 0.05). 24 patients in group A were examined by coronary angiography, 21 patients in group B and 3 patients in group A were completely occlusive immediately after operation. There was no collateral occlusion in group B. the average degree of collateral stenosis in group A was (65.32 鹵13.45)%, and the follow-up rate was (42.23 鹵15.43)%. The average degree of collateral stenosis in group B was (50.42 鹵15.32)%. The follow-up rate was (20.25 鹵11.53)%, and the difference between the two groups was statistically significant (P 0.05). Conclusion: in bifurcation lesions, double guide wire protection of side branch or important branch can significantly reduce the incidence of side branch loss after the implantation of the main branch stent of coronary bifurcation lesion, which can protect the side branch with double guide wire and put the side branch or important branch into the side branch compared with the traditional single guide wire. Prevent a significant increase in branch opening stenosis. At the same time, once the side branch is seriously involved, the guide wire can be exchanged smoothly, and the guide wire can be exchanged quickly, which can shorten the operation time, improve the safety of the operation, and at the same time reduce the number of side branch stent implantation. As a result, the cost of surgery is reduced. The protection of double guide wire is more effective than single guide wire in reducing myocardial injury, improving cardiac function and improving the quality of life of patients. Double lead protection of collateral vessels can reduce the severity of long-term coronary stenosis.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R54

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