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目的探讨慢性冠状动脉闭塞(CTO)患者的冠状动脉介入治疗(PCI)的安全性、可行性和影响因素。方法 136例CTO患者,术前给予常规药物治疗,经桡动脉或股动脉途径行PCI治疗,总结靶病变导丝通过率、PCI治疗即刻成功率、手术成功率的影响因素、手术时间、造影剂用量、术中及住院期间严重并发症发生率、术后心绞痛发作情况和心功能恢复情况。结果 136例患者人均CTO病变1.2处,人均置入支架1.3个。闭塞处导丝通过率为89%,PCI即刻成功率为80.9%,手术时间1～5 h,平均2.3 h。术后心绞痛发作显著减少(术前心绞痛均在Ⅱ级及以上,而术后Ⅱ级及以上心绞痛仅占36.3%),心功能明显改善(术前LVEF 0.43±0.08,术后3、6、12个月分别为0.48±0.09、0.53±0.11和0.55±0.10),术中或住院期间无死亡患者,未发生不可救治的严重并发症。结论CTO患者成功PCI治疗可提高患者生活质量,无严重并发症发生,且随着术者技术的成熟和器材改进,手术成功率明显提高。手术成功率与术者经验、患者全身情况、冠状动脉闭塞时间及闭寒病变的部位及特征、介入器械和手术技巧的合理应用等因素密切相关,与介入途径无明显相关。
Objective To investigate the safety, feasibility and influencing factors of coronary intervention (PCI) in patients with chronic coronary artery occlusion (CTO). Methods One hundred and sixty-six patients with CTO were treated with conventional drugs before operation and received PCI through the radial artery or femoral artery. The success rate of target guidewire, the immediate success rate of PCI, the influencing factors of operative success rate, operation time, contrast agent Dosage, intraoperative and inpatient rates of serious complications, postoperative angina attacks and cardiac function recovery. Results 136 patients per capita CTO lesions at 1.2, per capita placement of stent 1.3. Occlusion of guide wire through rate of 89%, PCI immediate success rate of 80.9%, operation time 1 ~ 5 h, an average of 2.3 h. Postoperative angina pectoris was significantly reduced (preoperative angina grade Ⅱ and above, and postoperative grade Ⅱ and above angina pectoris accounted for only 36.3%), cardiac function improved significantly (preoperative LVEF 0.43 ± 0.08, 3,6,12 after surgery Months were 0.48 ± 0.09,0.53 ± 0.11 and 0.55 ± 0.10), no intraoperative or hospitalized patients died of serious incurable complications. Conclusion Successful PCI in patients with CTO can improve the quality of life of patients without serious complications, and with the maturity of the technique and equipment improvements, the success rate of surgery increased significantly. The successful rate of operation was closely related to the experience of the surgeon, the general condition of the patient, the time and degree of coronary artery occlusion and the location and characteristics of the closed cold lesions, the reasonable application of interventional instruments and surgical skills, and no significant correlation with the interventional approach.