拘禁球囊技术与双导丝技术在冠状动脉分叉病变治疗中对分支开口保护的效果比较

目的 观察对比拘禁球囊技术(JBT)与双导丝技术治疗冠状动脉分叉病变对分支开口保护的优劣.方法 选择2010年9月至2016年5月在冀中能源峰峰集团总医院经冠脉造影确诊为冠状动脉分叉病变的81例患者,根据随机数字表法将所有患者分为两组:双导丝技术组(40例),采用双导丝技术治疗,根据单支架释放后边支血流情况,决定是否Rewire导丝;拘禁球囊技术组(41例),采用小内径球囊保护分支开口,主支单支架释放,同时边支球囊压力扩张保护,支架植入后,观察分支血流情况.对比两组患者在实施经皮冠状动脉介入治疗(PCI)时间、边支闭塞、曝光时间、对比剂用量、手术费用、术后主要不良心血管事件(MACE)、冠脉造影定量分析(QCA)等方面的差异.结果 双导丝技术组有10例发生边支闭塞,拘禁球囊技术组有2例发生边支闭塞,差异有统计学意义(P<0.05);与双导丝技术组比较,拘禁球囊技术组PCI实施时间及曝光时间更短、对比剂用量更少、手术费用更低,差异有统计学意义(P<0.05);术后1年随访,MACE发生率及QCA差异无统计学意义(P>0.05).绪论拘禁球囊技术治疗冠状动脉分叉病变可有效保护分支开口,降低边支闭塞率及手术费用,值得推广.

Comparison of effect of jailed balloon technique and double guide wire technique on protection of branch opening in treatment of bifurcation lesion in coronary artery

Objective To compare the effect of jailed balloon technique and double guide wire technique on branch opening protection in the treatment of coronary bifurcation disease. Methods Eighty-one patients with coronary bifurcation lesions diagnosed by coronary angiography from Sept 2010 to May 2016 in our hospital were selected and randomized into two groups. Double guide wire technique group (40 cases) was treated with double guide wire technique, and the application of Rewire guide wire was determined according to the blood flow condition of the side branch after the release of single stent. The jailed balloon technique group (41 cases) used small bore balloon to protect branch opening, and the side branch balloon would expand the protection when the main branch was released, then the flow of the branch was observed after the implantation of stent. The difference between the two groups was compared with respect to the time of percutaneous coronary intervention, the rate of occlusion, the time of exposure, the dosage of contrast agent, the cost of operation, the major adverse cardiovascular events after the operation, the quantitative analysis of coronary angiography and so on. Results The number of side branch occlusion in double guide wire group and the balloon group was 10 and 2 respectively, and the difference was statistically significant(P<0.05). Compared with double guide wire technique group, the time of PCI and exposure were shorter, the dosage of contrast medium was less, and the cost of operation was lower in jailed balloon technique group, and the difference was statistically significant (P<0.05). There was no significant difference in the incidence of MACE and QCA between the two groups during the one year follow-up (P> 0.05). Conclusion Jailed balloon technique can protect the branch opening, reduce the occlusion rate of side branches, and reduce the cost of operation in the treatment of coronary artery, and it is worth promotion.