经皮冠状动脉腔内成形术中应用多普勒导丝测定冠状动脉血流速度及血流储备功能的意义(摘要)
作者：魏盟 钱菊英 沈学东 樊冰 王齐冰 严卫 邵志丽 潘翠珍 戎卫海 陈灏珠
单位：上海市，上海医科大学中山医院 上海市心血管病研究所 心内科 (200032)
关键词：
中国循环杂志99zk31 目的：本文旨在用冠状动脉内多普勒血流速度描记技术评价经皮冠状动脉腔内成形术(PTCA)前后冠状动脉血流速度及冠状动脉血流储备的变化特点。
方法：冠心病病人25例(男20例，女5例)，平均年龄65.1±8.8岁(40～80岁)，对31支冠状动脉(右冠状动脉8支，左前降支16支，左回旋支7支)行PTCA。于PTCA前后用多普勒导丝分别记录狭窄近端和远端的平均峰值血流速度(APV)，狭窄近、远端血流速度比(P/DVR)，及冠状动脉血流速度储备(CFR)。
结果：PTCA前31支冠状动脉的直径狭窄率(均数±标准差)为(84.88±12.25)%(59.46%～97.5%)。PTCA后残余狭窄降至27.65%(10.32%～60.81%),术后病变冠状动脉近端APV较PTCA前有增加，但差别未达统计学意义(23.74±15.98 cm/s比27.36±18.32 cm/s,P=0.06),狭窄远端APV，充血相APV及CFR均较术前明显增加(15.07±11.63 cm/s比23.09±10.33 cm/s,41.67±17.43 cm/s比20.53±10.69 cm/s,1.2±0.4比1.81±0.66,P均<0.05),P/DVR则明显降低(1.84±1.06比1.45±0.74,P<0.05)。但残余狭窄的多少与PTCA后基础及充血相APV、CFR、P/DVR改善的程度之间并无明显的相关关系(r分别为-0.11、-0.11、-0.18和0.28,P均>0.05)。
, http://www.100md.com
结论：多普勒导丝测量技术可以更细致的评价PTCA前后冠状动脉血流模式的变化及PTCA术后的急性期疗效，是一种值得在临床上使用并进一步深入研究的新方法。
Significance of Measuring Coronary Blood Velocity and Coronary Blood Velocity Reserve with Doppler Wire before and after Percutaneous Transluminal Coronary Angioplasty (Abstract)
Department of Cardiology, Zhong Shan Hospital of Shanghai Medical University
and Shanghai Institute of Cardiovascular Diseases, Shanghai (200032)
, 百拇医药
Wei Meng, Qian Juying, Shen Xuedong, et al.
Objective: To assess coronary hemodynamics before and after percutaneous transluminal coronary angioplasty (PTCA) by intracoronary Doppler wire measurement.
Methods: Twenty-five patients with 31 diseased coronary arteries (LAD 16, RCA 8, LCX 7) were studied with intracoronary Doppler wire. The measurement included average peak velocity (APV) at proximal and distal, ratio of peak velocity (P/DVR) between proximal and distal, maximal distal APV and coronary flow reserve (CFR) at basic state and after PTCA.
, 百拇医药
Results: Narrowing percentage in diameter for the 31 coronary arteries decreased from (84.88±12.25) % (59.46%～97.5%) before PTCA to 27.65% (10.32%～60.81%) after PTCA. CFR, APV and maximal APV at distal significantly increased after PTCA (1.2±0.4 vs. 1.81±0.66, p<0.05, 15.07±11.63 cm/s vs. 23.09±10.33 cm/s, 41.67±17.43 cm/s vs. 20.53±10.69 cm/s, respectively, all p<0.05), APV at proximal tended to increase, but it is statisticly insignificant (p=0.06). P/DVR decreased significantly from (1.84±1.06 before PTCA to 1.45±0.74 after PTCA, p<0.05. However, the degree of stenosis decreasing did not show significant correlation with changes of basic APV, maximal APV, CFR and P/DVR after PTCA (r=-0.11, -0.11, -0.18, 0.28, respectively, all p>0.05).
Conclusion: Changes of coronary artery dynamics and acute effects measured by CFR after PTCA can be evaluated accurately with intracoronary Doppler wire measurement. The significance of this technique during PTCA needs further studies.
本研究获得上海市医学领先专业基金资助(94-01-Ⅲ), 百拇医药
单位：上海市，上海医科大学中山医院 上海市心血管病研究所 心内科 (200032)
关键词：
中国循环杂志99zk31 目的：本文旨在用冠状动脉内多普勒血流速度描记技术评价经皮冠状动脉腔内成形术(PTCA)前后冠状动脉血流速度及冠状动脉血流储备的变化特点。
方法：冠心病病人25例(男20例，女5例)，平均年龄65.1±8.8岁(40～80岁)，对31支冠状动脉(右冠状动脉8支，左前降支16支，左回旋支7支)行PTCA。于PTCA前后用多普勒导丝分别记录狭窄近端和远端的平均峰值血流速度(APV)，狭窄近、远端血流速度比(P/DVR)，及冠状动脉血流速度储备(CFR)。
结果：PTCA前31支冠状动脉的直径狭窄率(均数±标准差)为(84.88±12.25)%(59.46%～97.5%)。PTCA后残余狭窄降至27.65%(10.32%～60.81%),术后病变冠状动脉近端APV较PTCA前有增加，但差别未达统计学意义(23.74±15.98 cm/s比27.36±18.32 cm/s,P=0.06),狭窄远端APV，充血相APV及CFR均较术前明显增加(15.07±11.63 cm/s比23.09±10.33 cm/s,41.67±17.43 cm/s比20.53±10.69 cm/s,1.2±0.4比1.81±0.66,P均<0.05),P/DVR则明显降低(1.84±1.06比1.45±0.74,P<0.05)。但残余狭窄的多少与PTCA后基础及充血相APV、CFR、P/DVR改善的程度之间并无明显的相关关系(r分别为-0.11、-0.11、-0.18和0.28,P均>0.05)。
, http://www.100md.com
结论：多普勒导丝测量技术可以更细致的评价PTCA前后冠状动脉血流模式的变化及PTCA术后的急性期疗效，是一种值得在临床上使用并进一步深入研究的新方法。
Significance of Measuring Coronary Blood Velocity and Coronary Blood Velocity Reserve with Doppler Wire before and after Percutaneous Transluminal Coronary Angioplasty (Abstract)
Department of Cardiology, Zhong Shan Hospital of Shanghai Medical University
and Shanghai Institute of Cardiovascular Diseases, Shanghai (200032)
, 百拇医药
Wei Meng, Qian Juying, Shen Xuedong, et al.
Objective: To assess coronary hemodynamics before and after percutaneous transluminal coronary angioplasty (PTCA) by intracoronary Doppler wire measurement.
Methods: Twenty-five patients with 31 diseased coronary arteries (LAD 16, RCA 8, LCX 7) were studied with intracoronary Doppler wire. The measurement included average peak velocity (APV) at proximal and distal, ratio of peak velocity (P/DVR) between proximal and distal, maximal distal APV and coronary flow reserve (CFR) at basic state and after PTCA.
, 百拇医药
Results: Narrowing percentage in diameter for the 31 coronary arteries decreased from (84.88±12.25) % (59.46%～97.5%) before PTCA to 27.65% (10.32%～60.81%) after PTCA. CFR, APV and maximal APV at distal significantly increased after PTCA (1.2±0.4 vs. 1.81±0.66, p<0.05, 15.07±11.63 cm/s vs. 23.09±10.33 cm/s, 41.67±17.43 cm/s vs. 20.53±10.69 cm/s, respectively, all p<0.05), APV at proximal tended to increase, but it is statisticly insignificant (p=0.06). P/DVR decreased significantly from (1.84±1.06 before PTCA to 1.45±0.74 after PTCA, p<0.05. However, the degree of stenosis decreasing did not show significant correlation with changes of basic APV, maximal APV, CFR and P/DVR after PTCA (r=-0.11, -0.11, -0.18, 0.28, respectively, all p>0.05).
Conclusion: Changes of coronary artery dynamics and acute effects measured by CFR after PTCA can be evaluated accurately with intracoronary Doppler wire measurement. The significance of this technique during PTCA needs further studies.
本研究获得上海市医学领先专业基金资助(94-01-Ⅲ), 百拇医药