中国医学前沿杂志（电子版）
中國醫學前沿雜誌（電子版）
중국의학전연잡지（전자판）
CHINESE JOURNAL OF THE FRONTIERS OF MEDICAL SCIENCE(ELECTRONIC VERSION)
2013年
9期
69-73
,共5页
洪浪%王洪%李林锋%尹秋林%廖作银%涂伟玲
洪浪%王洪%李林鋒%尹鞦林%廖作銀%塗偉玲
홍랑%왕홍%리림봉%윤추림%료작은%도위령
冠状动脉%分叉病变%介入治疗%DK-Crush技术
冠狀動脈%分扠病變%介入治療%DK-Crush技術
관상동맥%분차병변%개입치료%DK-Crush기술
Coronary artery%True coronary bifurcation lesion%Interventional therapy%Double kissing crush technique2
目的探讨改良DK-Crush技术（即前送球囊DK-Crush技术）处理冠状动脉真性分叉病变的有效性和安全性。方法本研究连续入选2007年1月至2011年12月在本院住院，冠状动脉造影证实为真性分叉病变（分支血管直径≥2.0 mm）的患者共196例。随机分为两组，每组各98例，其中一组接受经典DK-Crush技术治疗，另外一组接受前送球囊DK-Crush技术治疗。比较两组患者临床特征、病变分布、曝光时间、手术时间、使用球囊数量、造影剂用量、手术相关费用、手术成功率，并记录出院后6个月临床随访时的主要心血管事件（MACE）发生率。结果两组患者基础临床特征差异无显著性，两组患者分叉病变分布差异无显著性。用前送球囊DK-Crush组与经典DK-Crush组患者的主干与分支血管之间的夹角[（54±18）°︰（49±15）°，P＝0.10]、主支血管病变长度[（22.5±7.1）mm︰（24.6±7.3）mm，P＝0.10]、手术成功率（98%±1%︰99%±1%，P＝0.33）、术后即刻分支血管开口部位最小血管直径[（2.72±0.29）mm∶（2.76±0.23）mm，P＝0.10]、残余狭窄率（6.8%±2.2%︰6.5%±2.6%，P＝0.10）差异均无显著性。前送球囊DK-Crush组与经典DK-Crush组比较，患者曝光时间短[（38±11）min∶（50±13）min，P＝0.03]、手术时间短[（65±17） min︰（78±18）min，P＝0.03]、使用球囊数量少[（1.7±0.4）个︰（2.6±0.7）个，P＝0.02]、造影剂使用量小[（68±25）ml︰(83±24）ml，P＝0.03]、手术相关费低[（45120±234）元︰（50284±245）元，P＝0.03]。6个月随访时前送球囊DK-Crush组患者的MACE事件发生率（5.7%±2.2%︰5.3%±1.6%，P＝0.08）、造影再狭窄率（7.8%±2.6%︰7.5%±2.2%，P＝0.10）差异均无显著性。结论改良的DK-Crush技术能显著缩短曝光时间、减少球囊数量，减少患者的手术费用，其6个月随访结果证实了其在有效性及安全性方面均与经典DK-Crush技术相当。
目的探討改良DK-Crush技術（即前送毬囊DK-Crush技術）處理冠狀動脈真性分扠病變的有效性和安全性。方法本研究連續入選2007年1月至2011年12月在本院住院，冠狀動脈造影證實為真性分扠病變（分支血管直徑≥2.0 mm）的患者共196例。隨機分為兩組，每組各98例，其中一組接受經典DK-Crush技術治療，另外一組接受前送毬囊DK-Crush技術治療。比較兩組患者臨床特徵、病變分佈、曝光時間、手術時間、使用毬囊數量、造影劑用量、手術相關費用、手術成功率，併記錄齣院後6箇月臨床隨訪時的主要心血管事件（MACE）髮生率。結果兩組患者基礎臨床特徵差異無顯著性，兩組患者分扠病變分佈差異無顯著性。用前送毬囊DK-Crush組與經典DK-Crush組患者的主榦與分支血管之間的夾角[（54±18）°︰（49±15）°，P＝0.10]、主支血管病變長度[（22.5±7.1）mm︰（24.6±7.3）mm，P＝0.10]、手術成功率（98%±1%︰99%±1%，P＝0.33）、術後即刻分支血管開口部位最小血管直徑[（2.72±0.29）mm∶（2.76±0.23）mm，P＝0.10]、殘餘狹窄率（6.8%±2.2%︰6.5%±2.6%，P＝0.10）差異均無顯著性。前送毬囊DK-Crush組與經典DK-Crush組比較，患者曝光時間短[（38±11）min∶（50±13）min，P＝0.03]、手術時間短[（65±17） min︰（78±18）min，P＝0.03]、使用毬囊數量少[（1.7±0.4）箇︰（2.6±0.7）箇，P＝0.02]、造影劑使用量小[（68±25）ml︰(83±24）ml，P＝0.03]、手術相關費低[（45120±234）元︰（50284±245）元，P＝0.03]。6箇月隨訪時前送毬囊DK-Crush組患者的MACE事件髮生率（5.7%±2.2%︰5.3%±1.6%，P＝0.08）、造影再狹窄率（7.8%±2.6%︰7.5%±2.2%，P＝0.10）差異均無顯著性。結論改良的DK-Crush技術能顯著縮短曝光時間、減少毬囊數量，減少患者的手術費用，其6箇月隨訪結果證實瞭其在有效性及安全性方麵均與經典DK-Crush技術相噹。
목적탐토개량DK-Crush기술（즉전송구낭DK-Crush기술）처리관상동맥진성분차병변적유효성화안전성。방법본연구련속입선2007년1월지2011년12월재본원주원，관상동맥조영증실위진성분차병변（분지혈관직경≥2.0 mm）적환자공196례。수궤분위량조，매조각98례，기중일조접수경전DK-Crush기술치료，령외일조접수전송구낭DK-Crush기술치료。비교량조환자림상특정、병변분포、폭광시간、수술시간、사용구낭수량、조영제용량、수술상관비용、수술성공솔，병기록출원후6개월림상수방시적주요심혈관사건（MACE）발생솔。결과량조환자기출림상특정차이무현저성，량조환자분차병변분포차이무현저성。용전송구낭DK-Crush조여경전DK-Crush조환자적주간여분지혈관지간적협각[（54±18）°︰（49±15）°，P＝0.10]、주지혈관병변장도[（22.5±7.1）mm︰（24.6±7.3）mm，P＝0.10]、수술성공솔（98%±1%︰99%±1%，P＝0.33）、술후즉각분지혈관개구부위최소혈관직경[（2.72±0.29）mm∶（2.76±0.23）mm，P＝0.10]、잔여협착솔（6.8%±2.2%︰6.5%±2.6%，P＝0.10）차이균무현저성。전송구낭DK-Crush조여경전DK-Crush조비교，환자폭광시간단[（38±11）min∶（50±13）min，P＝0.03]、수술시간단[（65±17） min︰（78±18）min，P＝0.03]、사용구낭수량소[（1.7±0.4）개︰（2.6±0.7）개，P＝0.02]、조영제사용량소[（68±25）ml︰(83±24）ml，P＝0.03]、수술상관비저[（45120±234）원︰（50284±245）원，P＝0.03]。6개월수방시전송구낭DK-Crush조환자적MACE사건발생솔（5.7%±2.2%︰5.3%±1.6%，P＝0.08）、조영재협착솔（7.8%±2.6%︰7.5%±2.2%，P＝0.10）차이균무현저성。결론개량적DK-Crush기술능현저축단폭광시간、감소구낭수량，감소환자적수술비용，기6개월수방결과증실료기재유효성급안전성방면균여경전DK-Crush기술상당。
Objective To compare the effectiveness and safeness in bifurcation coronary lesion between Modified DK Crush technique and Classical DK Crush technique. Methods This was a consecutive, randomized, open-label study. 196 consecutive patients with single true coronary bifurcation lesion according to Lefevre Classiifcation and side branch diameter ≥2.0 mm were enrolled into the study. All patients were randomized classiifed to 2 groups, they were assigned to receive classical DK Crush technique and Modiifed DK Crush technique,respectively. Compared the clinical characteristcs, lesion distribution, x-ray exposure time, procedure time, balloon count, volume of contrast consumed, fee related to the procedure and success rate of the procedure between the two groups. Six mouths later, we recorded the incidence of MACE (main adverse cardiac events) and restenosis rate of the two groups. Results There was no statistical differences between the two group in clinical characteristcs, lesion distribution, bifurication angle[(54±18)° vs (49±15)°, P=0.10], lesion length in the main vessel[ (22.5±7.1) mm vs (24.6±7.3) mm, P=0.10], success rate of the procedure [(98%±1%) vs (99%±1%), P=0.33], minimum lumen diameter (MLD) at side branch ostium [(2.72±0.29) mm vs (2.76±0.23) mm, P = 0.10] and degree of residual stenosis at ostial side branch [(6.8%±2.2%) vs (6.5%±2.6%), P=0.10]. Patients in the Modiifed DK Crush group, compared with those in the classical DK Crush group, were characterized by shorter x-ray exposure time [(38±11) min vs (50±13) min, P = 0.03], shorter procedure time [(65±17) min vs (78±18) min, P = 0.03], less balloon applicati on (1.7±0.4 vs 2.6±0.7, P=0.02), lower volume of contrast consumed [(68±25) ml vs (83±24) ml, P=0.03] and lower fee r-elated to the procedure [(45 120±234) yuan vs (50 284±245) yuan, P=0.03]. There was no statistical differences between the two groups in the incidence of MACE [(5.7%±2.2%) vs (5.3%±1.6%), P = 0.08] and restenosis rate [(7.8%±2.6%) vs (7.5%±2.2%), P=0.10] after 6 mouths. Conclusion Comparing with classical DK Crush techniques, Modiifed DK Crush techniques had the potential to reduce x-ray exposure time, saved ballon application and reduced the fee related to the procedure. Six months follow-up results conifrmed that the effectiveness and safeness of Modified DK Crush techniques were similar to classical DK Crush techniques.
