臺灣博碩士論文加值系統

中 文 摘 要
本研究主要目的在於追蹤統計中部地區某醫學中心導管室，施以氣球導管擴張術(plain old balloon angioplasty)與帶刀片氣球擴張術(cutting balloon angioplasty) ，治療冠狀動脈血管支架再狹窄(in-stent resteosis)病灶之成效與國內一般傳統氣球擴張治療方法的優劣比較。研究方法採用回溯性搜集2003年1月到2006年12月於該院所有置放冠狀動脈血管支架的患者資料，統計裝置血管支架日期與支架數量，以回溯性之病例對照研究分析患者門診追蹤情形及再發生缺血性心臟病患者之影像。在國內大部份醫院執行冠狀動脈(coronary artery)氣球擴張術時，皆以傳統氣球導管作為首要選擇，過程中若因擴張而造成血管壁剝離(dissection)反而會導致冠狀動脈的阻塞，會藉由放置冠狀動脈支架(stent)，將剝離塌落的血管內壁重新撐起，若血管壁剝離太嚴重即使是冠狀動脈支架亦無法補救，必須接受外科(繞道手術)治療。本研究發現在中部地區某醫學中心導管室，是全國施以帶刀片氣球導管擴張術病患人數最多的醫院，治療心血管阻塞皆以帶刀片氣球導管為主要治療方式，醫師進行治療病灶時，首先選用直徑小於血管直徑的氣球導管作前置擴張，再選用血管直徑與帶刀片氣球導管直徑比例1:1或1:1.5作擴張術治療，以低壓力、多次數慢慢進行治療避免因機械性擴張將病灶斑塊擠壓破裂導致嚴重血管壁剝離(dissection)。
本研究結果經過統計分析發現此醫學中心以帶刀片氣球導管治療方式與傳統氣球導管治療之比較，在心血管支架再狹窄率(14%)及氣球導管治療再狹窄率(10%)皆遠低於國內外文獻報告(35% - 50%)。因此以帶刀片氣球導管擴張術作為治療的首要選擇，對患者有更顯著的安全與治療效益。

Abstract
The object of this study is tracking and analyzing the effect of using plain old balloon angioplasty(POBA)and cutting balloon angioplasty(CBA) for treating in-stent restenosis after coronary artery stents has implanted in a hospital center located in central Taiwan area compared with traditional domestic therapies. Patient data was collected between Jan. 2003 and Dec. 2006 for all patients with coronary artery stents and stents sizes and numbers were analyzed according to the outpatient service situation. Physicians use POBA to treat coronary artery stenosis with small size balloon first as pre-extending operation then choose blade cutting balloon which are 1:1 or 1:1.5 ratio compared to blood vessel to do the following expanding procedure. The re-stenosis ratio of this low pressure and repeated slow progress coronary artery expanding is far smaller than study report compared with traditional POBA after statistic analyzed. Most domestic centers which perform cath therapies usually choose plain old balloon angioplasty at beginning but coronary artery may cause plaque rupture and lead to coronary artery obstruction, at this moment coronary artery stent may support the subside vessel from the inside of vessel. Sometimes it is too serious of the plaque rupture and even coronary artery stent is not working then bypass is needed. This study analyzed and focused on cutting balloon angioplasty as main treaty in which we find out that in stent re-stenosis (14%)and balloon plasty(10%) are quite lower compared with reports from domestic or foreign ( 35% - 50% ) so cutting balloon catheter can give patients the most safe margin and benefit as first chose.

目 錄
頁次
致謝................................................................Ⅲ
中文摘要.............................................................Ⅳ
英文摘要.............................................................Ⅴ
目錄................................................................VI
圖目錄...............................................................Х
表目錄.............................................................ХІІ
第一章 緒論...........................................................1
1.1研究動機..........................................................1
1.2研究背景及目的.....................................................3
1.3實驗架構..........................................................4
1.4英文縮寫及中文說明..................................................5
1.5文獻回顧..........................................................6
第二章 冠狀動脈血管與心血管再狹窄病變的基礎..............................9
2.1冠狀動脈.........................................................9
2.1.1冠狀動脈生理...................................................10
2.1.2冠心症生理變化.................................................11
2.1.3冠狀動脈血管病灶的分類及定義.....................................12
2.2心臟病病理機轉與臨床危險因子........................................13
2.2.1 高血壓導致冠狀動脈血管狹宰.....................................13
2.2.2 糖尿病導致冠狀動脈血管狹窄.....................................13
2.2.3 高脂血症導致冠狀動脈血管狹窄...................................14
2.3 血管再狹窄的機制................................................16
2.3.1 血管再狹窄的發生.............................................16
第三章 實驗材料與方法.................................................19
3.1受檢者取樣之選擇..................................................19
3.1.1病人追蹤條件...................................................19
3.1.2 排除病人追蹤理由.............................................20
3.2 實驗儀器........................................................21
3.2.1心導管雙向X光設備..............................................21
3.3 冠狀動脈介入性治療材料............................................22
3.3.1 冠狀動脈介入性檢查(Angiogram)..................................22
3.3.2 氣球導管擴張術(POBA).........................................25
3.3.3 血管支架置放術(Stent)........................................26
3.3.4 帶刀片氣球導管擴張術( Cutting balloon angioplasty).............28
3.3.5 冠狀動脈繞道手術.............................................30
3.4 實驗方法與步驟...................................................31
3.4.1 研究的設計目標...............................................31
3.4.2 侵入性治療的選擇及步驟........................................31
3.4.3 臨床治療效果評估.............................................32
3.5 統計方法........................................................33
第四章 結果.........................................................35
4.1 血管內支架再狹窄治療方式分析.......................................35
4.2 血管支架再狹窄患者人數統計學與基本生理特性...........................37
4.3 血管支架內再狹窄病灶特性.........................................38
4.4 治療處置的特性..................................................39
4.5 第二次再狹窄病患治療結果.........................................40
4.6 再狹窄病患治療接受帶刀片氣球擴張術中產生的併發症....................41
4.7 再狹窄病患治療接受傳統氣球擴張術中產生的併發症......................42
第五章 討論..........................................................43
5.1 帶刀片氣球導管及傳統氣球導管擴大血管管腔的機制的探討.................43
5.2 帶刀片氣球導管及傳統氣球導管處置的探討.............................44
5.3 帶刀片氣球導管及傳統氣球導管治療在狹窄併發症的探討...................45
5.4 帶刀片氣球導管及傳統氣球導管治療追蹤時的研究限制的探討...............46
第六章 結論及未來方向.................................................47
參考文獻............................................................48

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