胡昊,吴佳纬,余晓凡,李龙伟,余东彪,孔祥勇,李丹,华锦胜,周俊岭,陈鸿武,冯克福,余华,马礼坤

• 1:中国科学技术大学附属第一医院(安徽省立医院)心脏中心

摘要(Abstract)：

目的探讨对冠状动脉严重钙化病变直接行冠状动脉旋磨术和药物洗脱支架置入术后的效果。方法纳入2014年7月至2017年8月中国科学技术大学附属第一医院心脏中心行冠状动脉旋磨术患者101例,分为预扩张失败旋磨组35例和直接旋磨组66例。分析两组患者冠状动脉造影资料、临床信息、术中并发症发生率、手术成功率,并通过电话及门诊随访。结果直接旋磨组使用血管内超声(IVUS)比例显著高于预扩张失败旋磨组(39.4%比14.3%,P=0.009),而手术时间[(55.1±10.0)min比(94.3±21.6)min,P<0.001]及对比剂用量[(108.7±18.5)ml比(176.7±29.1)ml,P=0.008]均明显低于预扩张失败旋磨组;直接旋磨组所用磨头直径[(1.38±0.22)mm比(1.42±0.13)mm,P=0.012]、预扩张使用球囊数[(1.1±0.2)个比(2.6±0.4)个,P=0.009]及使用支架数量[(2.1±0.3)枚比(2.8±0.6)枚,P=0.014]均少于预扩张失败旋磨组,差异均有统计学意义。两组患者术中并发症发生率比较,直接旋磨组术中夹层(3.0%比40.0%,P<0.001)、术后心力衰竭(3.0%比31.4%,P<0.001)发生率均明显低于预扩失败旋磨组。直接旋磨组术后6个月支架内再狭窄发生率(0.0比11.4%,P=0.004)、靶病变血运重建发生率(3.0%比17.1%,P=0.003)及主要不良心血管事件(MACE)发生率(6.1%比34.3%,P<0.001)均明显低于预扩张失败旋磨组。结论对于严重钙化病变,直接旋磨术可有效降低介入手术并发症发生率,且术后6个月MACE发生率较低。

关键词(KeyWords)： 旋磨术;钙化病变;药物支架置入术

Abstract:

Keywords:

基金项目(Foundation): 安徽省公益性技术应用研究联动计划(15011d04032);; 安徽省科技攻关计划(1604a0802074)

作者(Author): 胡昊,吴佳纬,余晓凡,李龙伟,余东彪,孔祥勇,李丹,华锦胜,周俊岭,陈鸿武,冯克福,余华,马礼坤

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