目的：经皮冠状动脉腔内成形术(PTCA)与冠状动脉内支架(ICS)术都可以有效的恢复冠状动脉狭窄引起的冠状动脉血流异常，本文旨在采用冠状动脉内多普勒血流速度描记技术来评价PTCA及ICS在恢复冠状动脉血流作用上的特点及差异。

方法：冠心病患者21例(男性18例，女3例)，平均年龄64.1±5.4(57～80)岁，对23支狭窄的冠状动脉(左前降支15支，右冠状动脉6支，左回旋支2支)进行了PTCA，之后均置入了ICS(15例为预防性，4例为扩张不满意，2例为严重夹层分离)。所有病例均在介入治疗前及PTCA和ICS后采用多普勒导丝描记技术分别记录狭窄近端和远端的平均峰值流速(APV)，狭窄近、远端血流速度比(P/DVR)及冠状动脉血流储备(CFR)，比较两种方法在恢复冠状动脉血流模式上的差异。

结果：23支冠状动脉的狭窄从PTCA前的平均88.52%(60.3%～97.5%)降至平均37.23%(17.45%～68.26%),置入ICS后降至0.68%(-2.10%～7.44%)。有2支因狭窄严重，介入治疗前未能进行多普勒导丝检查。其余均获得了完整的检查资料。结果显示，PTCA后狭窄远端APV及充血相APV、CFR明显高于术前(21.71±6.60 cm/s对12.89±6.62 cm/s、30.69±16.61 cm/s对13.54±8.68 cm/s、1.81±0.66对1.30±0.46,P均＜0.05),狭窄近端APV、P/DVR较术前分别有增高及下降趋势，但差别均无统计学意义(P＞0.05)。置入ICS后上述指标进一步改善，与PTCA后比较，充血相APV及CFR又有明显增高，分别为47.61±14.32 cm/s对30.69±16.61 cm/s和2.16±0.68 cm/s对1.81±0.66 cm/s(P＜0.05),但狭窄近端APV及P/DVR两组间无显著差别(P＞0.05)。

结论：PTCA可使狭窄远端的基础、充血相血流速度及CFR明显增加，但P/VDR下降不明显，ICS则可进一步增加狭窄远端的基础、充血相血流速度及CFR，并使P/VDR明显下降，表明ICS可更有效的恢复冠状动脉的正常血流及改善CFR。采用冠状动脉内血流速度描记技术可以更精确地评价PTCA及ICS的急性期治疗效果。

Assessment of Coronary Hemodynamics after Coronary Balloon Angioplasty

and Intracoronary Stenting with Doppler Wire (Abstract)

Department of cardiology, Zhong Shan Hospital of Shanghai

medical University and Shanghai Institute of Cardiovascular Diseases, Shanghai(200032)

wei Meng, Qian Juying, Shen Xuedong, et al.

objective: Both percutaneous transluminal coronary balloon agnioplasty (PTCBA) and intracoronary stenting (ICS) are effective techniques to recanalize narrowing coronary arteries, studies with Doppler wire on evaluating coronary hemodynamics during interventional therapy were sparsely documented in this country. We used Doppler wire to assess and compare changes of coronary hemodynamics before and after both PTCA and ICS.

Methods: twenty-one patients with 23 diseased coronary arteries (LAD 15, RCA 6, LCX 2) were studied with intracoronary Doppler wire. The measurement included recording average peak velocity (APV) at proximal and distal segments, ratio of peak velocity (P/DVR) between proximal and distal, maximal distal APV and coronary flow reserve (CFR) at basic state, and after PTCA and ICS.

Results: narrowing percentage in diameter for the 18 coronary arteries decreased from88.52% (60.3%～97.5%) before PTCA to 37.23% (17.45%～68.26%) after PTCA, and to 0.68% (-2.10%～7.44%) after ICS. Coronary hemodynamics at basic state in 2 coronary arteries were not measured because Doppler wire could not arrive at the distal segments, for the others, all data needed were obtained. The results showed that APV and maximal aPV at distal as well as CRF significantly increased after PTCA (21.71±6.6 cm/s vs. 12.89±6.62 cm/s, 30.69±16.61 cm/s vs. 13.54±8.68 cm/s, 1.81±0.66 vs.1.30±0.46, respectively, all p＜0.05), APV at proximal tended to increase, and P/DVR to decrease, but neither significantly (p＞0.05). After ICS, CFR, aPV and maximal APV at distal further significantly increased (28.21±8.04 cm/s vs. 12.89±6.62 cm/s, 47.61±14.32 cm/s vs. 3.54±8.68 cm/s, 1.11±0.47 vs. 2.19±1.23,2.16±0.68 vs. 1.30±0.46, respectively, all p＜0.05), meanwhile P/DVR decreased to normal range (1.11±0.47 vs. 2.19±1.23, p＜0.05), APV increase at proximal was insignificant (p＞0.05). Compared PTCA with ICS, maximal APV at distal and CFR after ICS were significantly higher than after PTCA (47.61±14.32 cm/s vs. 30.69±16.61 cm/s, 2.16±0.68 vs. 1.81±0.66, respectively, all p＜0.05), but differences between APVs at distal and proximal, P/DVRs in these two groups were not significant (all p＞0.05).

Conclusion: aPV and maximal APV as well as CFR measured with Doppler wire increased significantly after PTCA and ICS, P/DVR decreased insignificantly after PTCA, but significantly after ICS, CFR after ICS was significantly higher than after pTCA, these indicated that ICS could more effectively improve coronary circulation. Doppler wire can be used to evaluate acute results of PTCBA and iCS.