作者：王海涛，马翠，王彬

单位：

071000河北省保定市第二医院心血管内科 通信作者：王海涛，E-mail：stethoa580@21cn.com

Units：

Department of Cardiology, Baoding Second Hospital, Baoding 071000, China Corresponding author: WANG Haitao, E-mail: stethoa580@21cn.com

关键词：

冠状动脉分叉病变; 支架置入术; 利伐沙班; 双导丝边支保护技术; 心功能; 生活质量;

Keywords：

Coronary bifurcation lesion; Stent implantation; Rivaroxaban; Double guidewire side branch protectiontechnology; Cardiac function; Quality of life

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.081

Funds：

河北省医学科学研究课题（20200167）

摘要：

目的 探讨利伐沙班联合双导丝边支保护技术对冠状动脉分叉病变（CBL）患者边支狭窄、心功能及生活质量的影响。方法 选取2019年4月至2021年5月保定市第二医院收治的180例CBL患者作为研究对象，采用随机数字表法将其分为研究组和常规组，每组90例。常规组患者于支架植入术中采取双导丝边支保护技术，研究组患者在常规组治疗基础上给予利伐沙班治疗，两组患者均持续治疗1个月。比较两组患者治疗6个月后边支狭窄率和边支闭塞发生率，治疗前及治疗6个月后血小板活化相关因子[包括血管性血友病因子（vWF）和血管紧张素Ⅱ（AngⅡ）]水平和心功能指标[包括脑钠肽（BNP）、心肌肌钙蛋白T(cTnT)及左心室射血分数（LVEF）]，治疗期间不良反应发生情况。结果 治疗6个月后，研究组患者边支狭窄率、边支闭塞发生率低于常规组（P<0.05）。治疗6个月后，两组患者vWF、AngⅡ水平分别低于本组治疗前，且研究组患者低于常规组（P<0.05）。治疗6个月后，两组患者BNP、cTnT分别低于本组治疗前，LVEF分别高于本组治疗前（P<0.05）；治疗6个月后，研究组患者BNP、cTnT低于常规组，LVEF高于常规组（P<0.05）。治疗6个月后，两组患者生理功能、生理职能、躯体疼痛、一般健康状况、情感职能、社会功能、活力、精神健康评分分别高于本组治疗前，且研究组患者高于常规组（P<0.05）。两组患者治疗期间不良反应发生率比较，差异无统计学意义（P>0.05）。结论 利伐沙班联合双导丝边支保护技术可有效降低CBL患者支架植入术后边支狭窄率及边支闭塞发生风险，减轻血管内皮损伤，降低血栓形成风险，改善患者心功能及生活质量，且未增加药物不良反应发生风险。

Abstract：

【Abstract】　Objective To investigate the impact of rivaroxaban combined with double guidewire side branch protectiontechnology on side branch stenosis, cardiac function and quality of life in patients with coronary bifurcation lesion (CBL) after stentimplantation.Methods A total of 180 patients with CBL admitted to Baoding Second Hospital from April 2019 to May 2021 wereselected as the study subjects, and they were divided into study group and routine group by random number table method, with90 patients in each group. Patients in the routine group were treated with double guidewire side branch protection technologyduring stent implantation, while patients in the study group were treated with rivaroxaban based on the routine group, both groupswere continuously treated for 1 month. The side branch stenosis rate and incidence of side branch occlusion after 6 months oftreatment, level of platelet activation related factors [including von willehemophiliac factor (vWF) and angiotensin Ⅱ (AngⅡ) ]and cardiac function indexes [including brain natriuretic peptide (BNP) , cardiac troponin T (cTnT) and left ventricular ejectionfraction (LVEF) ] before treatment and after 6 months of treatment, and the incidence of adverse reactions during treatmentwere compared between the two groups.Results After 6 months of treatment, the side branch stenosis rate and incidence ofside branch occlusion in the study group were lower than those of the routine group (P <0.05) . After 6 months of treatment, thelevels of vWF and AngⅡ in the study group and the routine group were lower than those before treatment, respectively, and aboveindicators in the study group were lower than those in the routine group (P <0.05) . After 6 months of treatment, the levels ofBNP and cTnT in the study group and the routine group were lower than those before treatment, and LVEF was higher than thatbefore treatment, respectively (P <0.05) ; after 6 months of treatment, BNP and cTnT in the study group were lower than those inthe routine group , and LVEF was higher than those in the routine group (P <0.05) . After 6 months of treatment, the scores ofphysiological function, role physical, physical pain, general health, body pain, social function, vitality and mental health of the twogroups were higher than those before treatment, respectively, and above indicators in the study group were higher than those inthe routine group (P <0.05) . There was no significant difference in the incidence of adverse reactions during treatment betweenthe two groups (P > 0.05) . Conclusion Rivaroxaban combined with double guide wire edge branch protection technology caneffectively reduce the side branch stenosis rate and the risk of side branch occlusion in patients with CBL after stent implantation,reduce vascular endothelial injury and risk of thrombosis, improve cardiac function and quality of life, and do not increase the riskof adverse reactions.

ReferenceList：