梁颖　黄汉辉　赖天幸　邹端　林彩燕　陈晞明　严鹏科

[摘要] 目的 探讨紫杉醇药物涂层球囊治疗冠脉支架内再狭窄的临床效果。 方法 选择2015年1月～2016年12月广州医科大学附属第三医院收治的87例冠脉支架内再狭窄患者，按随机数字表法将其分为对照组（43例）和治疗组（44例）。对照组给予药物洗脱支架治疗，治疗组给予紫杉醇药物涂层球囊治疗。观察并比较两组术后1、6、12个月的心血管不良事件发生率及两组术后12个月时的支架内再狭窄发生率。 结果 治疗组术后心血管不良事件总发生率（6.82%）及术后12个月时支架内再狭窄发生率（6.82%）均明显低于对照组（23.26%、27.91%），差异有统计学意义（χ2=4.623，P = 0.032；χ2=6.778，P = 0.009）。 结论 紫杉醇药物涂层球囊治疗冠脉支架内再狭窄的临床效果显著，能够明显减少心血管不良事件的发生，可避免再次置入支架，值得临床推广应用。

[关键词] 冠脉支架内再狭窄；紫杉醇；药物涂层球囊；药物洗脱支架

[中图分类号] R654.2 [文献标識码] A [文章编号] 1673-7210（2018）09（b）-0043-03

[Abstract] Objective To explore the clinical efficacy of drug-coated balloon with Paclitaxel for treatment of coronary in-stent restenosis. Methods Eighty-seven patients with coronary in-stent restenosis admitted to the Third Affiliated Hospital of Guangzhou Medical University from January 2015 to December 2016 was divided into control group （43 cases） and treatment group （44 cases） by random number table method. Control group was treated with drug-eluting stent， while treatment group was treated with drug-coated balloon with Paclitaxel. The rate of cardiovascular adverse events after operation for 1， 6， 12 months and the incidence of coronary in-stent restenosis after operation for 12 months of the two groups were observed and compared. Results The total rate of cardiovascular adverse events and the incidence of coronary in-stent restenosis of treatment group （6.82%， 6.82%） were both lower than those of control group （23.26%， 27.91%） after operation for 12 months， the differences were statistically significant （χ2=4.623， P = 0.032； χ2=6.778， P = 0.009）. Conclusion The drug-coated balloon with Paclitaxel is effective in the treatment of coronary in-stent restenosis， it can reduce the incidence of cardiovascular adverse events and avoid placing stents again， it is worthy of promotion and application in clinic.

[Key words] Coronary in-stent restenosis； Paclitaxel； Drug-coated balloon； Drug-eluting stent

冠心病是一种临床常见急症，指冠状动脉粥样硬化导致管腔闭塞或狭窄，引起心肌缺血、缺氧或坏死所致的心脏病，严重影响着人们的身体健康[1]。目前，冠状动脉支架植入术是治疗冠心病的主要措施，然而冠脉支架内再狭窄是支架放置后的主要并发症，发生率高达15%～30%，制约着冠状动脉支架植入术的远期疗效[2]。近年来研究发现，药物涂层球囊治疗冠脉支架内再狭窄具有较好的效果，其以球囊导管为介质，将抗增殖药物输送到病变部位，使得药物均一、高浓度地释放至病变部位，从而在局部发挥作用，避免了体内多聚物、金属结构的残留，既能够抑制内膜增殖和平滑肌生长，又对机体无长期的毒副作用[3-5]。……