冠状动脉内支架置入术1 000例——单中心经验分析
作者：高润霖 陈纪林 杨跃进
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目的 目的：本文旨在用冠状动脉内多普勒血流速度描记技术观察并比较不同狭窄程度冠状动脉的血流速度及其储备功能的变化。
方法：选择49例进行冠状动脉造影病人，根据造影结果分为A组：冠状动脉正常；B组：冠状动脉轻、中度狭窄(<70%)和C组：冠状动脉严重狭窄(>70%)。采用多普勒导丝分别记录各组冠状动脉近端和远端的平均峰值血流速度(APV)，近、远端血流速度之比(P/DVR)，充血相的APV及冠状动脉血流速度储备(CFR)。A组检查17例病人，冠状动脉43支(右冠15支，前降支17支，回旋支11支)；B组检查11例病人，冠状动脉25支(右冠8支，前降支9支，回旋支8支)；C组检查20例病人，冠状动脉22支(右冠6支，前降支13支，回旋支3支)。
, http://www.100md.com
结果：A组与B组的近、远端APV均相差不大，P/DVR不高，但B组近、远端APV比A组明显增加(P<0.05),CFR降低(P<0.05)，而充血相APV及P/DVR两组无明显差别(P均>0.05)；C组狭窄远端APV明显低于近端APV(P<0.01)，狭窄远端无明显充血相反应，近端APV明显高于A组(P<0.05)，而于B组无明显差别(P均>0.05)，狭窄远端APV、狭窄远端充血相APV及CFR明显低于A组及B组，P/DVR则明显高于A组和B组(P均<0.001)。
结论：冠状动脉轻度狭窄者近、远血流速度比虽无明显异常，但血流速度已代偿性增加，储备功能下降。重度狭窄者狭窄远端血流速度明显减慢，充血相血流速度及冠状动脉储备功能明显下降，近、远端流速比明显增高。相对于基础血流速度而言，冠状动脉远端的充血相血流速度、血流储备及近、远端流速比能更敏感地反应狭窄病变引起的功能变化。
Clinical Assessment of Coronary Circulation in Normal and Diseased Coronary
, http://www.100md.com
Arteries with Intracoronary Doppler Flow Velocity Measurements (Abstract)
Department of Cardiology, Zhong Shan Hospital of Shanghai
Medical University and Shanghai Institute of Cardiovascular Diseases, Shanghai (200032)
Wei Meng, Shao Zhili, Shen Xuedong, et al.
Objective: To Investigate and compare features of coronary blood velocity and coronary flow reserve in normal and diseased coronary arteries.
, http://www.100md.com
Methods: Using Doppler guide wire to measure parameters of coronary blood velocity, including proximal and distal average peak velocity (APV), ratio of proximal and distal peak velocity (P/DVR), maximal APV and coronary flow reserve (CFR), in 49 patients with normal or diseased coronary arteries. According to the results of coronary angiogram, three groups were divided. i. e. group A with normal coronary arteries, including 17 patients and 43 coronary arteries (RCA 15, LAD 17, LCX 11); Group B with intermediate lesions (<70%), including 11 patients and 25 coronary arteries (RCA 8, LAD 9, LCX 8); Group C with severe stenosis (>70%), including 20 patients and 22 coronary arteries (RCA 6, LAD 13, LCX ).
, http://www.100md.com
Results: Both of group A and group B got similar P/DVR and maximal APV (1.15±0.33 vs. 1.17±0.30 and 46.17±13.77 cm/s vs. 44.27±15.28 cm/s, respectively, p>0.05). Baseline proximal and distal APVs in group B were significantly higher than it in group A (22.27±7.80 cm/s vs. 18.31±5.35 cm/s and 19.89±7.64 cm/s vs. 16.80±5.72 cm/s, respectively, p<0.05), CFR in group B was significantly lower than it in group A (2.16±0.86 vs. 3.19±0.67, p<0.05). In group C, distal APVs at baseline and at maximal state were significantly lower than proximal APV at baseline (14.46±10.21 cm/s and 21.58±14.22 cm/s vs. 24.13±14.56 cm/s, p<0.001 and p<0.05, respectively), compared with group A and group B, the proximal APV was significantly higher than it in group A, and similar to it in group B (24.13±14.56 cm/s vs. 16.80±5.72 cm/s, p<0.05, and vs. 22.27±7.80 cm/s, p>0.05)， the distal APVs at basic state and at maximal state as well as CFR were much lower than it in group A and group B (14.46±10.21, 21.58±14.22 cm/s, 1.44±0.86 vs. 19.89±7.64 cm/s, 44.27±15.28 cm/s, 2.16±0.86 and 16.80±5.72 cm/s, 46.17±13.77 cm/s, 3.19±0.67, respectively, p<0.001), however, the P/DVR was much higher than it in the other two groups (1.89±0.93 vs. 1.15±0.33, 1.17±0.30, p<0.001).
, 百拇医药
Conclusion: Although P/DVR in patients with intermediate lesion is within normal range, the accelerated blood velocity and the decreased CFR indicate that coronary circulation function has become impaired. For patients with severe lesion, distal APV and CFR decreased and P/VDR increased remarkably. CFR measurement with Doppler wire can sensitively and effectively evaluate effects of different lesions on coronary circulation function.
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：
关键词：
目的 目的：本文旨在用冠状动脉内多普勒血流速度描记技术观察并比较不同狭窄程度冠状动脉的血流速度及其储备功能的变化。
方法：选择49例进行冠状动脉造影病人，根据造影结果分为A组：冠状动脉正常；B组：冠状动脉轻、中度狭窄(<70%)和C组：冠状动脉严重狭窄(>70%)。采用多普勒导丝分别记录各组冠状动脉近端和远端的平均峰值血流速度(APV)，近、远端血流速度之比(P/DVR)，充血相的APV及冠状动脉血流速度储备(CFR)。A组检查17例病人，冠状动脉43支(右冠15支，前降支17支，回旋支11支)；B组检查11例病人，冠状动脉25支(右冠8支，前降支9支，回旋支8支)；C组检查20例病人，冠状动脉22支(右冠6支，前降支13支，回旋支3支)。
, http://www.100md.com
结果：A组与B组的近、远端APV均相差不大，P/DVR不高，但B组近、远端APV比A组明显增加(P<0.05),CFR降低(P<0.05)，而充血相APV及P/DVR两组无明显差别(P均>0.05)；C组狭窄远端APV明显低于近端APV(P<0.01)，狭窄远端无明显充血相反应，近端APV明显高于A组(P<0.05)，而于B组无明显差别(P均>0.05)，狭窄远端APV、狭窄远端充血相APV及CFR明显低于A组及B组，P/DVR则明显高于A组和B组(P均<0.001)。
结论：冠状动脉轻度狭窄者近、远血流速度比虽无明显异常，但血流速度已代偿性增加，储备功能下降。重度狭窄者狭窄远端血流速度明显减慢，充血相血流速度及冠状动脉储备功能明显下降，近、远端流速比明显增高。相对于基础血流速度而言，冠状动脉远端的充血相血流速度、血流储备及近、远端流速比能更敏感地反应狭窄病变引起的功能变化。
Clinical Assessment of Coronary Circulation in Normal and Diseased Coronary
, http://www.100md.com
Arteries with Intracoronary Doppler Flow Velocity Measurements (Abstract)
Department of Cardiology, Zhong Shan Hospital of Shanghai
Medical University and Shanghai Institute of Cardiovascular Diseases, Shanghai (200032)
Wei Meng, Shao Zhili, Shen Xuedong, et al.
Objective: To Investigate and compare features of coronary blood velocity and coronary flow reserve in normal and diseased coronary arteries.
, http://www.100md.com
Methods: Using Doppler guide wire to measure parameters of coronary blood velocity, including proximal and distal average peak velocity (APV), ratio of proximal and distal peak velocity (P/DVR), maximal APV and coronary flow reserve (CFR), in 49 patients with normal or diseased coronary arteries. According to the results of coronary angiogram, three groups were divided. i. e. group A with normal coronary arteries, including 17 patients and 43 coronary arteries (RCA 15, LAD 17, LCX 11); Group B with intermediate lesions (<70%), including 11 patients and 25 coronary arteries (RCA 8, LAD 9, LCX 8); Group C with severe stenosis (>70%), including 20 patients and 22 coronary arteries (RCA 6, LAD 13, LCX ).
, http://www.100md.com
Results: Both of group A and group B got similar P/DVR and maximal APV (1.15±0.33 vs. 1.17±0.30 and 46.17±13.77 cm/s vs. 44.27±15.28 cm/s, respectively, p>0.05). Baseline proximal and distal APVs in group B were significantly higher than it in group A (22.27±7.80 cm/s vs. 18.31±5.35 cm/s and 19.89±7.64 cm/s vs. 16.80±5.72 cm/s, respectively, p<0.05), CFR in group B was significantly lower than it in group A (2.16±0.86 vs. 3.19±0.67, p<0.05). In group C, distal APVs at baseline and at maximal state were significantly lower than proximal APV at baseline (14.46±10.21 cm/s and 21.58±14.22 cm/s vs. 24.13±14.56 cm/s, p<0.001 and p<0.05, respectively), compared with group A and group B, the proximal APV was significantly higher than it in group A, and similar to it in group B (24.13±14.56 cm/s vs. 16.80±5.72 cm/s, p<0.05, and vs. 22.27±7.80 cm/s, p>0.05)， the distal APVs at basic state and at maximal state as well as CFR were much lower than it in group A and group B (14.46±10.21, 21.58±14.22 cm/s, 1.44±0.86 vs. 19.89±7.64 cm/s, 44.27±15.28 cm/s, 2.16±0.86 and 16.80±5.72 cm/s, 46.17±13.77 cm/s, 3.19±0.67, respectively, p<0.001), however, the P/DVR was much higher than it in the other two groups (1.89±0.93 vs. 1.15±0.33, 1.17±0.30, p<0.001).
, 百拇医药
Conclusion: Although P/DVR in patients with intermediate lesion is within normal range, the accelerated blood velocity and the decreased CFR indicate that coronary circulation function has become impaired. For patients with severe lesion, distal APV and CFR decreased and P/VDR increased remarkably. CFR measurement with Doppler wire can sensitively and effectively evaluate effects of different lesions on coronary circulation function.
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