沈迎,丁风华,张瑞岩,杨震坤,胡健,沈卫峰

• 1:上海交通大学医学院附属瑞金医院心脏科

摘要(Abstract)：

目的验证经微导管测定冠状动脉闭塞远端压力(Pd)的精确性,并探讨该方法在评估冠状动脉侧支循环中的作用。方法连续入选249例稳定型心绞痛伴至少一支冠状动脉完全闭塞3个月以上患者,于冠状动脉介入治疗时当导引钢丝通过闭塞病变后,应用微导管测定Pd,对其中40例(验证组)再用压力导丝进行压力测定。根据主动脉平均压和Pd计算冠状动脉侧支血流指数(collateral flow index,CFI)。结果 (1)经微导管测定的Pd与压力导丝测得值显著相关,组内相关系数为0.751(95%CI 0.611~0.840,P<0.001);两种方法计算的CFI也显著相关,组内相关系数为0.679(95%CI 0.391~0.830,P<0.001)。(2)Pd与主动脉收缩压、舒张压、平均压均显著相关(均P<0.001),但CFI仅与Pd相关(r=0.843,P<0.001),而与主动脉收缩压(r=-0.030)、舒张压(r=-0.051)和平均压(r=-0.057)无显著相关性(均P>0.05)。(3)女性、高龄(年龄≥70岁)、糖尿病、血脂异常、吸烟和肾功能减退患者Pd和CFI减低(均P<0.05),而高血压病患者Pd和CFI增高。结论介入治疗时,应用微导管可以精确地测定Pd,这可能对评估冠状动脉侧支循环状态和冠心病患者治疗具有重要的临床价值。

关键词(KeyWords)： 冠心病;慢性完全闭塞病变;侧支循环;经皮冠状动脉介入治疗

Abstract:

Keywords:

基金项目(Foundation): 上海市科委项目(14ZR1425800);; 上海交通大学医工结合研究项目

作者(Author): 沈迎,丁风华,张瑞岩,杨震坤,胡健,沈卫峰

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