贾若飞,朱华刚,李响,杨铎,李红,韩静,宋荟芬,金泽宁

• 1:首都医科大学附属北京安贞医院急诊危重症中心

摘要(Abstract)：

目的对急性心肌梗死(AMI)患者行血管内超声(IVUS)检查探测衰减斑块,观察及探讨衰减斑块患者行经皮冠状动脉介入治疗(PCI)术中情况及术后12个月临床随访结果。方法纳入2012年12月至2014年4月北京安贞医院急诊危重症中心收治的急性心肌梗死患者85例,行冠状动脉造影并进行IVUS检查,必要时行PCI术。根据IVUS是否探测到衰减斑块将患者分为衰减斑块组和非衰减斑块组,比较两组患者围术期IVUS影像学结果。球囊扩张术后TIMI血流情况及术后12个月主要不良心脑血管事件(MACCE)发生率。结果 85例AMI患者IVUS检测结果分为衰减斑块组35例(41.2%),非衰减斑块组50例(58.8%)。两组患者年龄、性别、合并糖尿病、合并高血压病、低密度脂蛋白胆固醇等方面比较,差异均无统计学意义(均P>0.05);衰减斑块组患者脑钠肽显著低于非衰减斑块组[(55.92±10.27)pg/ml比(60.32±9.22)pg/ml,P=0.029],差异有统计学意义。两组患者术前TIMI血流分级比较,差异均无统计学意义(P>0.05);但在球囊扩张术后,衰减斑块组患者TIMI血流0~Ⅱ级比例(37.1%比10.0%,P=0.003)显著高于非衰减斑块组,差异有统计学意义。IVUS探测下衰减斑块组患者病变血管截面积[(15.48±3.22)mm~2比(11.71±3.01)mm~2,P<0.001]、斑块面积[(14.40±4.11)mm~2比(10.69±2.85)mm~2,P<0.001]、斑块负荷[(87.42±3.83)mm~2比(80.14±4.18)mm~2,P<0.001]、参考血管截面积[(14.18±3.12)mm~2比(11.22±2.89)mm~2,P<0.001]、偏心性(68.6%比36.0%,P<0.001)显著大于非衰减斑块组,差异均有统计学意义。术后随访12个月,两组患者总MACCE发生率比较,差异无统计学意义(P>0.05)。结论在IVUS探测下发现的衰减斑块,可导致球囊扩张术后无复流及慢血流发生率的增加。

关键词(KeyWords)： 衰减斑块;血管内超声;主要不良心脑血管事件;靶血管再次血运重建

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 贾若飞,朱华刚,李响,杨铎,李红,韩静,宋荟芬,金泽宁

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