CAJ | 학술논문

目的：探讨冠状动脉造影（CAG）联合血流储备分数（FFR）在冠心病介入治疗中的临床应用价值。方法将CAG明确冠状动脉病变至少单支血管狭窄70％～90％的冠心病患者82例（147处病变），分为观察组和对照组。观察组40例共72处病变均应用压力导丝行心肌FFR测定，仅在FFR≤0．80的病变中植入药物洗脱支架（DES ），术后FFR≤0．80患者给予支架内球囊后扩张；对照组42例患者75处病变行经皮冠状动脉介治疗（PCI）常规植入DES。比较两组患者一般情况及危险因素（高血压、糖尿病、高脂血症、吸烟等）、病变个数、支架植入数目，住院费用以及手术6个月后主要不良事件发生率（M ACE）、心绞痛再发生率。结果观察组支架植入数目及住院费用明显少于对照组[（0．88±0．88）个 vs．（1．81±0．83）个，（4．72±2．30）万元 vs．（6．00±2．41）万元，P＜0．05]；观察组与对照组术后6个月均未出现全因死亡，其再发心肌梗死率、再次血运重建率、复发心绞痛分别为2．50％ vs ．0、2．50％ vs ．2．38％、5．00％ vs ．7．14％，差异无统计学意义（P＞0．05）。结论 CAG结合心肌FFR测定，能显著减少冠心病患者支架使用数量、减少医疗费用支出，术后6个月内不增加M ACE发生率及心绞痛的发作。
목적：탐토관상동맥조영（CAG）연합혈류저비분수（FFR）재관심병개입치료중적림상응용개치。방법장CAG명학관상동맥병변지소단지혈관협착70％～90％적관심병환자82례（147처병변），분위관찰조화대조조。관찰조40례공72처병변균응용압력도사행심기FFR측정，부재FFR≤0．80적병변중식입약물세탈지가（DES ），술후FFR≤0．80환자급여지가내구낭후확장；대조조42례환자75처병변행경피관상동맥개치료（PCI）상규식입DES。비교량조환자일반정황급위험인소（고혈압、당뇨병、고지혈증、흡연등）、병변개수、지가식입수목，주원비용이급수술6개월후주요불량사건발생솔（M ACE）、심교통재발생솔。결과관찰조지가식입수목급주원비용명현소우대조조[（0．88±0．88）개 vs．（1．81±0．83）개，（4．72±2．30）만원 vs．（6．00±2．41）만원，P＜0．05]；관찰조여대조조술후6개월균미출현전인사망，기재발심기경사솔、재차혈운중건솔、복발심교통분별위2．50％ vs ．0、2．50％ vs ．2．38％、5．00％ vs ．7．14％，차이무통계학의의（P＞0．05）。결론 CAG결합심기FFR측정，능현저감소관심병환자지가사용수량、감소의료비용지출，술후6개월내불증가M ACE발생솔급심교통적발작。
Objective To explore the clinical application value of coronary angiography (CAG) combined with fractional flow re-serve(FFR) in percutaneous coronary intervention treatment of coronary artery disease (CAD) .Methods 82 cases of CAD(147 le-sions) with single hemadostenosis at least 70% -90% were randomized into the observation group and the control group .The ob-servation group(40 cases ,72 lesions) was performed the myocardial FFR detection by the pressure guide wire and the drug-eluting stents(DES) were placed in the lesions only if FFR ≤0 .80 .The patients with postoperative FFR ≤0 .80 were given the in-stent post-balloon dilatation .The control group(42 cases ,75 lesions) underwent the percutaneous coronary intervention(PCI) for conduc-ting the routine DES implantation .The general condition ,risk factors(hypertension ,diabetese ,hyperlipidemia ,smoking ,etc .) ,num-ber of lesions ,implanted stents ,hospitalization cost ,occurrence rate of major adverse cardiac events (MACE) after postoperative 6 months and the angina recurrence rate were compared between the two groups .Results The number of used stents per patient and the hospitalization cost in the observation group were significantly lower than those in the control group [(0 .88 ± 0 .88) vs .(1 .81 ± 0 .83) ,(47 200 ± 2 3000)Yuan vs .(60 000 ± 2 4100)Yuan P< 0 .05] .The two groups had no all-cause death in postoperative 6-months .The recurrent myocardial infarction rate ,revascularization rate and recurrent angina in the two groups were 2 .50% vs .0 , 2 .50% vs .2 .38% and 5 .00% vs .7 .14% respectively ,the differences had no statistical significance(P>0 .05) .Conclusion CAG combined with FFR detection can significantly reduce the number of stents and the hospitalization cost without increasing the occur-rence rates of MACE and angina within postoperative 6 months in CAD patients .