【摘要】 目的探讨血流储备分数(fractional flow reserve,FFR)在冠状动脉复杂病变经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)中的应用价值。方法选取2012年1月至2013年6月在佛山市顺德区第一人民医院心血管内科和广东省人民医院心血管内科住院接受冠状动脉造影,被判定为冠状动脉复杂病变且准备行PCI的患者100例,所有患者均按指南行常规药物治疗,随机分为FFR指导PCI组(FFR组,50例)和造影指导常规PCI组(对照组,50例)。比较两组患者术中的手术时间、对比剂用量、放射剂量、支架数量、住院时间及术后12个月的主要不良心血管事件(MACE,包括心原性死亡、靶血管血运重建、不稳定型心绞痛、支架内血栓形成、心力衰竭等)发生率及左心室射血分数(LVEF)。结果两组患者的基线资料和病变分型、病变参照血管直径、支架置入前病变狭窄程度、支架置入后病变狭窄程度、PCI成功率、完全血运重建、PCI相关性心肌梗死等比较,差异均无统计学意义(均P>0.05)。FFR组的对比剂用量[(99.60±17.83)ml比(114.60±30.78)ml,P=0.004]及支架数量[(1.40±0.67)枚比(1.92±0.80)枚,P=0.001]均明显少于对照组,差异均有统计学意义。两组手术用时、住院时间及放射剂量比较,差异均无统计学意义(均P>0.05)。随访12个月,两组MACE发生率和LVEF分别比较,差异均无统计学意义(均P>0.05)。结论 FFR应用于冠状动脉复杂病变PCI中,可在不增加手术用时、住院时间及放射剂量的基础上明显减少对比剂用量及置入支架数量,但并未显著降低术后12个月的MACE事件发生率。更多还原

【Abstract】 Objective To investigate the clinical value of FFR in percutaneous coronary intervention in treatment of patients with complex coronary lesions. Methods From January 2012 to June2013,100 cases with complex coronary lesions under coronary angiography were randomly divided into the FFR group( PCI stategy according to FFR,n = 50) and the control group( PCI strategy according to angiography,n = 50). Comparison of operation time, contrast dose,radiation dose,stent numbers,hospital stays and rates of major adverse cardiac events( MACE: cardiac death, target vessel revascularization,unstable angina,stent thrombosis,heart failure and stroke) at 1 year follow up as well as the left ventricular ejection fraction( EF) were made. Results There was no statistical differences between the two groups in baseline data. Contrast dose [( 99. 60 ± 17. 83) ml vs.( 114. 60 ± 30. 78) ml,P =0. 004] and stent numbers [( 1. 40 ± 0. 67) vs.( 1. 92 ± 0. 80),P = 0. 001] were less in patients of FFR group. No significant differences were found in operation time,hospital stays,radiation dose and 1 year follow-up MACE rates between the control group and the FFR group. Conclusions Application of FFR in percutaneous coronary intervention in treatment of patients with complex coronary lesions can reduce the contrast dose and stent numbers,which do not increase the operation time,hospital stays,radiation dose and 1 year follow-up MACE incidence.更多还原