药物涂层球囊治疗老年冠心病的疗效及对MLD、TLR的影响
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摘要
目的 :探讨药物涂层球囊(DCB)对老年冠心病的治疗效果及对主支最小管腔直径(MLD)、靶病变血运重建(TLR)的影响。方法 :回顾性分析2016年4月—2017年3月我院收治的100例老年冠心病患者的临床资料,根据置入球囊的不同分为普通球囊组55例和药物涂层球囊组(DCB组)45例。比较两组不良心脏事件、再狭窄和TLR发生率及治疗前后MLD、心功能指标、心率变异性变化情况。结果 :两组不良心脏事件、再狭窄发生率比较,差异无统计学意义(P>0.05),DCB组TLR发生率高于普通球囊组(P<0.05);治疗后DCB组MLD高于普通球囊组(P<0.01);治疗后DCB组每分钟搏出量(SV)和左室射血分数(LVEF)水平高于普通球囊组,N-末端脑钠肽前体(NT-proBNP)水平低于普通球囊组(P<0.05);治疗后DCB组全部窦性心搏RR间期的标准差(SDNN)、RR间期平均值标准差(SDANN)、相邻RR间期差值的均方根(RMSSD)和相邻NN之差>50 ms的个数占总窦性心搏个数的百分比(PNN50)水平均高于普通球囊组(P<0.05)。结论:DCB治疗老年冠心病的疗效较好,可明显改善MLD、TLR,具有良好的应用价值。
Objective: To investigate the therapeutic effect of drug-coated balloon(DCB) on coronary heart disease in elderly patients and its effect on minimum lumen diameter(MLD) and target lesion revascularization(TLR). Methods: The clinical data of 100 elderly patients with coronary heart disease admitted to our hospital from April 2016 to March 2017 were retrospectively analyzed. The patients were divided into conventional balloon group(55 cases) and drug-coated balloon(DCB) group(45 cases) according to the different balloons. The incidences of adverse cardiac events, restenosis and TLR in the two groups and the changes of MLD, cardiac function indexes and heart rate variability before and after treatment were compared between the two groups. Results: There was no significant difference in the incidences of adverse cardiac events and restenosis between the two groups(P>0. 05). The incidence of TLR in the DCB group was higher than that in the conventional balloon group(P<0.05). After treatment, the MLD in the DCB group was higher than that in the conventional balloon group(P<0.01). After treatment, the levels of stroke volume(SV) per minute and left ventricular ejection fraction(LVEF) in the DCB group were higher than those in the conventional balloon group, while the level of N-terminal pro-brain natriuretic peptide(NT-proBNP) was lower than that in the conventional balloon group(P<0.05). After treatment, the standard diviation of NN intervals(SDNN), standard diviation of average of NN interals(SDANN), root mean square of the difference between adjacent RR intervals(RMSSD) and percentage of the difference between adjacent NN >50 ms in total sinus beats(PNN50) in the DCB group were higher than those in the conventional balloon group(P<0.05). Conclusion: DCB is effective in the treatment of coronary heart disease in elderly patients, which can significantly improve MLD and TLR and has good application value.
Objective: To investigate the therapeutic effect of drug-coated balloon(DCB) on coronary heart disease in elderly patients and its effect on minimum lumen diameter(MLD) and target lesion revascularization(TLR). Methods: The clinical data of 100 elderly patients with coronary heart disease admitted to our hospital from April 2016 to March 2017 were retrospectively analyzed. The patients were divided into conventional balloon group(55 cases) and drug-coated balloon(DCB) group(45 cases) according to the different balloons. The incidences of adverse cardiac events, restenosis and TLR in the two groups and the changes of MLD, cardiac function indexes and heart rate variability before and after treatment were compared between the two groups. Results: There was no significant difference in the incidences of adverse cardiac events and restenosis between the two groups(P>0. 05). The incidence of TLR in the DCB group was higher than that in the conventional balloon group(P<0.05). After treatment, the MLD in the DCB group was higher than that in the conventional balloon group(P<0.01). After treatment, the levels of stroke volume(SV) per minute and left ventricular ejection fraction(LVEF) in the DCB group were higher than those in the conventional balloon group, while the level of N-terminal pro-brain natriuretic peptide(NT-proBNP) was lower than that in the conventional balloon group(P<0.05). After treatment, the standard diviation of NN intervals(SDNN), standard diviation of average of NN interals(SDANN), root mean square of the difference between adjacent RR intervals(RMSSD) and percentage of the difference between adjacent NN >50 ms in total sinus beats(PNN50) in the DCB group were higher than those in the conventional balloon group(P<0.05). Conclusion: DCB is effective in the treatment of coronary heart disease in elderly patients, which can significantly improve MLD and TLR and has good application value.
引文
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[11]崔锦钢,吴元,赵冬云,等.主动脉内球囊反搏在急性冠状动脉综合征治疗中的临床应用及并发症情况分析[J].中国循环杂志,2015,30(2):107-110.
[12]许永乐,贾鑫,郭伟,等.紫杉醇药物涂层球囊治疗症状性下肢动脉硬化闭塞症的早中期结果[J].中华外科杂志,2016,54(8):617-619.
[13]刘鑫,黄浙勇,王齐兵.药物洗脱球囊治疗冠心病小血管病变的系统评价[J].实用医学杂志,2016,32(13):2220-2223.
[14]张天华,迟德财,姜维良.药物涂层球囊治疗下肢动脉硬化闭塞症的疗效[J].中国普通外科杂志,2016,25(12):1719-1724.
[15]管考华,杨巍,刘世诺,等.药物涂层球囊在冠状动脉介入治疗中的应用[J].中国老年学杂志,2017,37(5):1297-1300.
[2]于雪,王欣越,张闻多,等.紫杉醇药物涂层球囊治疗老年冠心病患者原发病变的疗效和安全性[J].中华老年医学杂志,2016,35(8):834-838.
[3]路亚枫,吕树铮,陈韵岱,等.冠心病临界病变患者血管因子与冠脉斑块形态学特征的相关性研究[J].中华急诊医学杂志,2015,24(3):267-272.
[4]张斯亮,刘地川,吴健,等.药物球囊与药物支架治疗支架内再狭窄的Meta分析[J].中国介入影像与治疗学,2015,12(12):735-740.
[5]Li Y,Wang C,Zuo G,et al.Drug-eluting balloons in the treatment of de-novo coronary lesions:a meta-analysis of randomized-controlled trials[J].Coronary Artery Disease,2016,27(6):467.
[6]邓婵翠,邓文文,许官学,等.冠心病PCI术后支架内再狭窄的相关因素分析[J].中国动脉硬化杂志,2017,25(3):278-283.
[7]胡静雯,葛雷,葛均波.一种新型后扩张技术和最终对吻球囊扩张对冠状动脉分叉病变介入治疗疗效的影响[J].上海医学,2015,38(11):805-810.
[8]刘佳,胡晶,刘海伟,等.单支架最终对吻球囊扩张治疗冠状动脉分叉病变效果临床研究[J].中国实用内科杂志,2015,35(10):843-847.
[9]赵杰,吴永健,钱杰,等.应用切割球囊联合单支架置入治疗冠状动脉分叉病变的临床观察[J].中国循环杂志,2016,31(6):546-549.
[10]郭伟,卫任.药物涂层球囊治疗周围动脉疾病的循证医学证据[J].中国普通外科杂志,2016,25(6):785-789.
[11]崔锦钢,吴元,赵冬云,等.主动脉内球囊反搏在急性冠状动脉综合征治疗中的临床应用及并发症情况分析[J].中国循环杂志,2015,30(2):107-110.
[12]许永乐,贾鑫,郭伟,等.紫杉醇药物涂层球囊治疗症状性下肢动脉硬化闭塞症的早中期结果[J].中华外科杂志,2016,54(8):617-619.
[13]刘鑫,黄浙勇,王齐兵.药物洗脱球囊治疗冠心病小血管病变的系统评价[J].实用医学杂志,2016,32(13):2220-2223.
[14]张天华,迟德财,姜维良.药物涂层球囊治疗下肢动脉硬化闭塞症的疗效[J].中国普通外科杂志,2016,25(12):1719-1724.
[15]管考华,杨巍,刘世诺,等.药物涂层球囊在冠状动脉介入治疗中的应用[J].中国老年学杂志,2017,37(5):1297-1300.