拘禁球囊保护技术在冠状动脉非左主干分叉病变介入治疗中的临床意义

目的分析拘禁球囊保护技术在冠状动脉非左主干分叉病变介入治疗中的临床意义。方法选取2017年3月—2018年10月肇庆市第二人民医院及肇庆医学高等专科学校附属医院收治的96例冠状动脉非左主干分叉病变病人作为研究对象,均证实存在心肌缺血证据,且冠状动脉造影明确诊断为真性分叉病变(依据Medina分型,其中111,101,011为真性分叉病变)。采用随机数字表法将其分为对照组与研究组,每组48例。术前1 d两组病人均口服氯吡格雷和阿司匹林肠溶片,剂量为300 mg,对照组进行拘禁导丝保护技术治疗,研究组进行拘禁球囊技术治疗。记录所有病人手术操作相关指标、术中术后并发症及不良反应情况。结果研究组手术操作时间、造影剂用量、X线曝光时间、支架植入数量、球囊数量、导丝数量少于对照组(P<0.05),术中胸痛、术中冠状动脉夹层、术中支架膨胀不全发生率及治疗费用均低于对照组(P<0.05);两组病人手术均成功,研究组和对照组术中心律失常、术中血流减慢,术后分支闭塞或夹层、术后血清肌钙蛋白/心肌酶水平升高、术后分支血流动力学改变发生率比较差异无统计学意义(P>0.05);研究组不良反应发生率为10.42%,对照组为27.08%,研究组低于对照组,差异有统计学意义(P<0.05)。结论拘禁球囊保护技术凭借操作简单、造影剂用量少、X线曝光时间短、支架植入少、球囊用量少、导丝用量少、治疗费用少等诸多优势适用于冠状动脉非左主干分叉病变介入治疗,并未增加术中术后并发症、不良反应等。

Clinical Research of Jailed Ballon Protection Technique in Interventional Treatment of Non-left Main Coronary Artery Bifurcation

Objective To analyse clinical value of jailed ballon protection technique in interventional treatment of non-left main coronary artery bifurcation.Methods Ninety-six patients with non-left main coronary artery bifurcation were randomly divided into the control group and study group,with 48 cases in each group.Evidence of myocardial ischemia was confirmed in all patients,and the diagnosis of true bifurcation lesions was confirmed by coronary angiography(111,101,011 of them were true bifurcation lesions according to Medina classification).One day before surgery,both groups were treated wtith clopidogrel and aspirin enteric-coated tablets at a dose of 300 mg.The control group was treated with detention guidewire protection technology,while the study group was treated with jailed ballon technique.Relevant indicators of operation,intraoperative and postoperative complications and adverse reactions were compared between two groups.Results After treatment,the operation time,contrast medium dosage,X-ray exposure time,number of stent implantation,number of balloon,number of guidewire,intraoperative chest pain,coronary artery dissection,stent insufficiency and the cost of treatment in the study group were lower than those in the control group(P<0.05).The operations were successful in both groups,and there was no significant difference in intraoperative arrhythmia,blood flow deceleration,postoperative branch occlusion or dissection,increased serum troponin/myocardial enzyme level,and branch hemodynamic changes between the study group and the control group(P>0.05).The incidence of adverse reactions in the study group was lower than that in the control group(10.42%vs 27.08%,P<0.05).Conclusion With the advantages of simple operation,less contrast agent,short X-ray exposure time,less stent implantation,less balloon,less guidewire,less treatment cost,jailed ballon protection technique was suitable for the interventional treatment of non-left main coronary artery bifurcation lesions without increasing intraoperative and postoperative complications and adverse reactions.