摘要
目的探讨左心辅助装置Impella保护经皮冠状动脉介入治疗(percutaneous coronary intervention, PCI)术治疗危重冠心病的效果。方法冠状动脉管腔狭窄伴严重左室射血分数降低的心血管疾病患者67例,根据左室射血分数下降程度、管腔狭窄支数,采用分层区组法随机分为观察组33例和对照组34例。对照组采用主动脉球囊反搏术(intra-aortic balloon pump, IABP)和PCI术进行治疗,观察组给予左心辅助装置Impella保护PCI术。比较2组支架一次性植入成功率、术中不良事件发生率及术后TIMI血流分级情况。术后6个月,比较2组左心室舒张末期容积、左心室收缩末期容积和左室射血分数及主要心血管事件发生率和生存率。结果观察组支架一次性植入率(90.91%)高于对照组(70.59%)(P<0.05),术中夹层、术中慢血流和术中无复流发生率(6.06%、9.09%、6.06%)与对照组(2.94%、11.76%、5.88%)比较差异无统计学意义(P>0.05)。PCI术前和术后2组TIMI血流分级比较差异无统计学意义(P>0.05),术后2组TIMI血流分级均较术前明显改善(P<0.05)。术后6个月,观察组和对照组左心室舒张末期容积[(52.37±2.21)、(52.64±2.31)mL]、左心室收缩末期容积[(36.36±2.71)、(36.45±2.33)mL]低于术前[(55.64±2.73)、(55.86±2.45)mL,(40.47±2.52)、(40.26±3.46)mL],左室射血分数[(41.12±3.17)%、(40.78±3.28)%]均高于术前[(28.53±2.42)%、(28.36±3.74)%](P<0.05);术前和术后6个月,2组左心室舒张末期容积、左心室收缩末期容积和左室射血分数比较差异均无统计学意义(P>0.05)。术后6个月,观察组主要心血管事件发生率(39.39%)低于对照组(64.71%)(P<0.05),存活率(93.94%)与对照组(91.17%)比较差异无统计学意义(P>0.05)。结论左心辅助装置Impella保护PCI术可用于危重症冠心病患者治疗,有助于提高手术效率,减少术后心血管不良事件的发生,患者近期预后较佳。
Objective To investigate the efficacy of percutaneous coronary intervention(PCI) under left ventricular assist device Impella protection on critical coronary heart disease. Methods Sixty-seven patients with coronary artery luminal stenosis complicated with severe left ventricular ejection fraction(LVEF) reduction were randomly divided into observation group(n=33) and control group(n=34) by the stratified blocked method according to the degree of LVEF reduction and the count of artery with luminal stenosis. Control group received intra-aortic balloon pump(IABP) and PCI, and observation group received PCI under left ventricular assist device Impella protection. The success rate of one-time stent implantation, the incidence of intraoperative adverse events and postoperative TIMI stages were compared between two groups. The cardiac indexes as left ventricular end-diastolic volume(LVEDV), left ventricular end-systolic volume(LVESV), LVEF, the incidence of major cardiovascular events and survival rate were compared between two groups 6 months after operation. Results The success rate of one-time stent implantation was higher in observation group(90.91%) than that in control group(70.59%)(P<0.05), and there were no significant differences in the incidences of intraoperative dissection, slow blood flow and no-reflow between observation group(6.06%, 9.09%, 6.06%) and control group(2.94%, 11.76%, 5.88%)(P>0.05). TIMI blood flow grades showed no significant differences between two groups both before and after operation(P>0.05),and were improved after operation in both group(P<0.05).LVEDV((52.37±2.21),(52.64±2.31)mL)and LVESV((36.36±2.71),(36.45±2.33)mL)in observation group and control group 6 months after operation were lower than those before operation(LVEDV:(55.64±2.73),(55.86±2.45)mL;LVESV:(40.47±2.52),(40.26±3.46)mL),and LVEF was higher in observation group((41.12±3.17)%)and control group((40.78±3.28)%)6 months after operation than that before operation((28.53±2.42)%,(28.36±3.74)%)(P<0.05),while all the above showed no significant differences between two groups both before operation and 6 months after operation(P>0.05).The incidence of major cardiovascular events was lower in observation group(39.39%)than that in control group(64.71%)(P<0.05),and the survival rate showed no significant difference between two groups(93.94%vs.91.17%)6 months after operation(P>0.05).Conclusion PCI under left ventricular assist device Impella protection can be used in the treatment of critical coronary heart disease,it can improve the efficacy and reduce the risk for postoperative adverse cardiovascular events,and the short-term prognosis is fine.
作者
苏丰鸣
吴晓光
张凯
郑晓晖
SU Fengming;WU Xiaoguang;ZHANG Kai;ZHENG Xiaohui(Heart Center,Henan Provincial People’s Hospital,Central China Fuwai Hospital,Central China Fuwai Hospital of Zhengzhou University,Zhengzhou 450003,China)
出处
《中华实用诊断与治疗杂志》
2020年第8期840-843,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
河南省科技厅国际合作项目(172102410011)。
关键词
冠心病
经皮左心室辅助装置
IMPELLA
保护性PCI术
coronary heart disease
percutaneous left ventricular assist device
Impella
protective percutaneous coronary intervention
