吴章英,朱丽,李苏,黄嘉,戴宇翔

• 1:复旦大学附属中山医院心血管内科
• 2:青岛市黄岛区人民医院心血管内科
• 3:复旦大学附属中山医院心脏介入中心

摘要(Abstract)：

目的 探讨经皮冠状动脉腔内冲击波球囊导管成形术（IVL）和冠状动脉斑块旋磨术（RA）对冠状动脉钙化处理的安全性。方法 回顾性配对选取2021年12月至2025年4月于复旦大学附属中山医院进行介入治疗的210例重度冠状动脉钙化患者作为研究对象，按照手术处理方式分为IVL组（105例）和RA组（105例）。比较两组患者手术参数、术后心肌损伤标志物、院内主要不良心血管事件（MACE）发生率。结果 倾向性匹配分析前，IVL组与RA组靶血管中，左前降支比例（77.1%比63.8%,P=0.034）、右冠状动脉比例（14.3%比30.5%,P=0.005）比较，差异均有统计学意义；靶血管狭窄率[85%(80%,90%)比80%(80%,90%),P=0.014]，差异有统计学意义。倾向性匹配分析后，两组患者靶血管比例、靶血管狭窄率比较，差异均无统计学意义（均P>0.05）；在手术过程中，IVL组与RA组支架置入率、药物球囊使用率、支架直径及总长度比较，差异均无统计学意义（均P>0.05）;IVL组患者术后应用替罗非班比率高于RA组，但静脉注射硝酸酯类药物比率低于RA组，差异均无统计学意义（均P>0.05）。倾向性匹配分析前，IVL组与RA组，术前c Tn T水平差异无统计学意义（P=0.525），术后c Tn T水平差异有统计学意义（P=0.038）；院内心肌梗死发生率差异无统计学意义（8.6%比16.2%,P=0.094），且均无死亡及靶血管血运重建。倾向性匹配分析后，IVL组与RA组，术前cTnT水平差异无统计学意义（P=0.235），术后c Tn T水平差异有统计学意义（P=0.014）。尽管两组均无死亡及靶血管血运重建，但是在院内心肌梗死发生率上，IVL组显著低于RA组（9.9%比23.9%,P=0.025）。结论 采用IVL对严重冠状动脉钙化患者进行预处理，安全性高，具有临床应用价值。

关键词(KeyWords)： 冠状动脉钙化;经皮冠状动脉腔内冲击波球囊导管成形术;冠状动脉斑块旋磨术;冠状动脉狭窄

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金面上项目（82370357）

作者(Author): 吴章英,朱丽,李苏,黄嘉,戴宇翔

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