[摘要] 目的 探讨血管内超声(IVUS)在诊断冠状动脉粥样硬化、指导及评价经皮冠状动脉介入(PCI)中的作用。方法 对106例行冠状动脉造影(CAG)患者的152处冠状动脉血管段于支架置入术前、67处血管段于术后及21处于高压球囊扩张后进行IVUS检测。结果 IVUS在显示血管壁的形态结构、斑块的性质方面，其敏感性高于CAG；诊断冠心病更准确，CAG低估冠脉病变的严重程度。本组152处血管，经CAG和IVUS检查符合介入治疗干预指征的血管67处，IVUS指导确定置入支架的大小、长度以及置入的位置。置入支架后行IVUS以及CAG评价即刻效果，IVUS显示支架打开理想46处，需高压球囊再扩张21处。再扩张后行IVUS检查显示支架开放良好21处。CAG显示支架植入后效果理想67处，无须再行高压扩张，两者比较差异有非常显著性(P<0.001)。支架置入术后，血管总截面积、管腔面积增加、斑块面积及面积狭窄率降低；高压球囊扩张前后斑块面积差异无显著性，血管总截面积、管腔面积、面积狭窄率差异有显著性。结论 IVUS诊断冠心病的敏感性和特异性均为100%，IVUS是诊断冠心病的金标准；IVUS能准确选择支架置入的适应证，帮助选择支架大小；支架置入后可精确评价支架扩张是否充分。IVUS是目前指导支架置入和评价支架置入效果的最佳手段。

    [关键词] 动脉粥样硬化；冠状动脉造影；血管内超声；经皮冠状动脉介入

    Importance of intravascular ultrasound in percutaneous coronary interventions for patients with coronary heart disease

    TIAN Hui-yu.Nangang Branch,The Second Hospital of Heilongjiang Province,Harbin 150001,China

    [Abstract] Objective To explore the value of intravascular ultrasound (IVUS) in the diagnosis of coronary atherosclerosis,the guidance and evaluation of percutaneous coronary intervention (PCI).Methods One hundred and six cases which underwent coronary angiography (CAG) were enrolled to undergo IVUS preoperatively in the stent implantation of 152 coronary segments,post operatively in 67 segments and 21 segments of balloon dilation.Results IVUS was more sensitive than CAG in terms of detecting the morphologic changes of vessel wall and characteristics of atherosclerotic plaques.CAG underestimated coronary diseases compared to IVUS.In 152 vessel segments,67 segments were indicated for intervention by CAG and IVUS.The size and length of stents along with implantation sites were decided with IVUS assist.IVUS and CAG were performed post-operatively to assess the effects.46 segments were dilated successfully and 21 segments after balloon dilation which were assessed by IVUS,while all of 67 segments were evaluated successful by CAG.There were significant differences between IVUS evaluation and CAG evaluation (P<0.001).Conclusion IVUS is gold standard for coronary heart diseases’ diagnosis with 100% of sensitivity and specificity.IVUS can determine the indications of PCI and stents’ size,and evaluate the effects of PCI. ......