血管內(nèi)超聲指導(dǎo)導(dǎo)絲通過技術(shù)開通冠狀動(dòng)脈慢性閉塞性病變臨床療效探討

周浩

[摘要] 目的 探討血管內(nèi)超聲指導(dǎo)導(dǎo)絲通過技術(shù)開通冠狀動(dòng)脈慢性閉塞性病變的臨床療效。方法 方便選取該院2015年1月—2017年1月所收治的120例行冠狀動(dòng)脈造影檢查診斷為慢性完全閉塞病變（CTO）并行經(jīng)皮冠脈介入治療（PCI）的住院患者作為研究對(duì)象，將其隨機(jī)分為研究組和對(duì)照組，各60例；研究組施以血管內(nèi)超聲（IVUS）指導(dǎo)導(dǎo)絲通過技術(shù)治療，對(duì)照組未使用血管超聲指導(dǎo)，對(duì)比兩組臨床效果。 結(jié)果 研究組經(jīng)IVUS指導(dǎo)導(dǎo)絲通過技術(shù)治療后，其支架植入的成功率為93.33%，比對(duì)照組71.67%明顯偏高（P<0.05）；且研究組患者的手術(shù)時(shí)間、造影劑用量以及曝光時(shí)間均比對(duì)照組患者明顯優(yōu)越，組間差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；經(jīng)6個(gè)月隨訪表明，研究組并發(fā)癥發(fā)生率為3.33%，比對(duì)照組患者36.67%明顯偏低（P<0.05）。結(jié)論 血管內(nèi)超聲指導(dǎo)導(dǎo)絲通過技術(shù)開通冠狀動(dòng)脈慢性閉塞性病變的臨床療效顯著，有助于提高PCI的即刻成功率，減少手術(shù)時(shí)間，促進(jìn)患者康復(fù)。

[關(guān)鍵詞] 血管內(nèi)超聲指導(dǎo)；冠狀動(dòng)脈；慢性閉塞性病變

[中圖分類號(hào)] R541 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1674-0742（2017）11（b）-0188-03

[Abstract] Objective This paper tries to evaluate the clinical efficacy of intravascular ultrasound guided guidewire in chronic coronary artery occlusion. Methods 120 patients underwent coronary angiography for the diagnosis of chronic total occlusion （CTO） and percutaneous coronary intervention （PCI） in this hospital from January 2015 to January 2017 were conveniently selected as the research objects and were randomly divided into the study group and the control group， with 60 cases in each group； the study group was treated with intravascular ultrasound （IVUS） guiding wire through technical treatment， the control group did not use vascular ultrasound guidance， and then the clinical effect of two groups were compared. Results The study group by IVUS guiding wire through technical treatment after stent implantation， the success rate was 93.33%， significantly higher than the control group of 71.67%（P<0.05）； and the patients in the study group， operation time， contrast agent dosage and exposure time were significantly superior than the control group， and the differences between groups were significant（P<0.05）； after 6 months of follow-up， the incidence of complications was 3.33%， significantly lower than the control group of 36.67%（P<0.05）. Conclusion The clinical curative effect of intravascular ultrasound guided by guidewire technology for chronic coronary artery total occlusion lesions in PCI can improve the immediate success rate， reduce the operation time， and promote the rehabilitation of patients.

[Key words] Intravascular ultrasound guidance； Coronary arteries； Chronic occlusive diseases

冠狀動(dòng)脈慢性完全閉塞性病變（CTO）是指閉塞時(shí)大于3個(gè)月的病變，CTO病變約占全部冠狀動(dòng)脈造影確診為冠狀動(dòng)脈粥樣硬化性心臟病的30%以上[1-2]。目前接受經(jīng)皮冠狀動(dòng)脈介入治療（PCI）者不足8%，CTO病變相應(yīng)手術(shù)成功率低，且術(shù)后再閉塞以及再狹窄的發(fā)生率較高。相關(guān)醫(yī)學(xué)研究表明[3-4]，導(dǎo)絲通過失敗是臨床上CTO病變介入治療不成功的關(guān)鍵原因，在導(dǎo)絲通過過程中經(jīng)常會(huì)進(jìn)入至內(nèi)膜下的假腔，造成導(dǎo)絲前進(jìn)不暢，極易引發(fā)冠脈穿孔等各類型并發(fā)癥。隨著超聲技術(shù)的不斷發(fā)展，血管內(nèi)超聲指導(dǎo)（IVUS）技術(shù)已經(jīng)被廣泛應(yīng)用于CTO病變的介入治療，對(duì)于治療冠狀動(dòng)脈慢性閉塞性病變的臨床療效顯著[3，5]。該研究方便選取該院在2015年1月—2017年1月120例所收治的行冠狀動(dòng)脈造影檢查診斷為慢性完全閉塞病變（CTO）并行經(jīng)皮冠脈介入治療（PCI）的住院患者作為研究對(duì)象，分別施以血管內(nèi)超聲（IVUS）指導(dǎo)導(dǎo)絲通過技術(shù)治療以及未使用血管超聲指導(dǎo)導(dǎo)絲治療，對(duì)比二者的效果，現(xiàn)報(bào)道如下。endprint