本文選題：SYNTAX積分　切入點(diǎn)：EURO積分　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:SYNTAX積分27及Euro積分6分雙高冠心病高�；颊�,通過比較經(jīng)皮冠狀動(dòng)脈介入治療(Percutaneous Coronary Intervention PCI)或藥物治療后不良心血管事件發(fā)生率,指導(dǎo)心內(nèi)科臨床醫(yī)生,制訂適宜我國(guó)Syntax積分及Euro積分雙高冠心病高�；颊叩膫�(gè)體化治療策略。方法:回顧性分析研究2014年1月至2015年6月中國(guó)人民解放軍白求恩國(guó)際和平醫(yī)院心內(nèi)科冠脈造影證實(shí)為左主干病變和(或)三支病變,SYNTAX積分27分及Euro積分6分(簡(jiǎn)稱:SE雙高積分)的冠心病高�；颊�101例。根據(jù)患者選擇治療方法的不同,分為單純口服藥物治療組(簡(jiǎn)稱:藥物治療組)和PCI組。通過查閱住院病歷,門診或電話隨訪,記錄患者出院后發(fā)生不良心血管事件的時(shí)間和類型。觀察指標(biāo):1.主要不良心血管終點(diǎn)事件:全因死亡、非致死性心肌梗死、靶血管重建。2.次要不良心血管終點(diǎn)事件:心功能減退、心源性再入院、再發(fā)心絞痛。分別計(jì)算PCI治療組和藥物治療組主要不良心血管事件發(fā)生率和次要不良心血管事件發(fā)生率,通過卡方檢驗(yàn)來判別兩組之間的不良心血管事件發(fā)生率是否有區(qū)別,并對(duì)不良心血管事件做Kaplan-Meier分析,繪制無(wú)不良心血管事件生存曲線,對(duì)生存曲線進(jìn)行Log Rank(Mantel-Cox)檢驗(yàn),并對(duì)相關(guān)危險(xiǎn)因素進(jìn)行Cox比例風(fēng)險(xiǎn)回歸分析。結(jié)果:1隨訪到18個(gè)月時(shí),藥物治療組發(fā)生主要不良心血管事件(Major Adverse Cardiovascular Events MACE)17例(占藥物治療組34.00%),PCI組發(fā)生MACE 6例(占PCI組11.76%),兩組MACE發(fā)生率差異有統(tǒng)計(jì)學(xué)意義,P=0.008,PCI組MACE發(fā)生率低于藥物治療組。藥物治療組發(fā)生心功能減退21例(占藥物治療組42.00%),PCI組發(fā)生心功能減退10例(占PCI組19.61%),兩組心功能減退發(fā)生率有統(tǒng)計(jì)學(xué)意義,P=0.015,PCI組心功能減退發(fā)生率低于藥物治療組;藥物治療組發(fā)生心源性再入院25例(占藥物治療組50.00%),PCI組發(fā)生心源性再入院11例(占PCI組21.57%),兩組心源性再入院發(fā)生率有統(tǒng)計(jì)學(xué)意義,P=0.003,PCI組心源性再入院發(fā)生率低于藥物治療組;藥物治療組發(fā)生再發(fā)心絞痛21例(占藥物治療組42.00%),PCI組發(fā)生再發(fā)心絞痛9例(占PCI組17.64%),兩組再發(fā)心絞痛發(fā)生率有統(tǒng)計(jì)學(xué)意義,P=0.007,PCI組再發(fā)心絞痛發(fā)生率低于藥物治療組。2 Kaplan-Meier結(jié)果示:藥物治療組無(wú)不良心血管事件生存時(shí)間平均值9.660±0.868月,95%置信區(qū)間(7.959-11.361月),PCI組無(wú)不良心血管事件生存時(shí)間平均值12.725±0.870月,95%置信區(qū)間(11.021-14.430月)。3對(duì)藥物治療組和PCI組生存曲線做Log Rank(Mantel-Cox)檢驗(yàn),P=0.001,差異有統(tǒng)計(jì)學(xué)意義。4采用逐步回歸法對(duì)相關(guān)危險(xiǎn)因素:治療方法、性別、吸煙史、慢性肺部疾病、糖尿病、高血壓、高血脂、SYNTAX積分、Euro積分進(jìn)行Cox比例風(fēng)險(xiǎn)回歸分析,Cox模型似然比檢驗(yàn)P=0.001,配合模型時(shí),進(jìn)入模型和從模型中剔除的水準(zhǔn)分別為0.05和0.10,篩選后的最佳模型包含1個(gè)協(xié)變量:治療方法,P=0.001,其對(duì)應(yīng)的回歸系數(shù)為0.882,相對(duì)危險(xiǎn)度為2.416,說明SYNTAX積分及Euro積分雙高冠心病高�；颊哌x擇藥物治療發(fā)生不良心血管事件的風(fēng)險(xiǎn)是選擇介入治療的2.416倍。結(jié)論:1 SYNTAX積分及Euro積分雙高冠心病高�；颊咴诓捎肞CI治療后,與藥物治療組比,長(zhǎng)期隨訪(≥6個(gè)月)發(fā)現(xiàn)主要和次要不良心血管事件發(fā)生率都有明顯降低。2 SYNTAX積分及Euro積分雙高冠心病高�；颊逷CI治療組患者無(wú)不良心血管事件的平均生存時(shí)間和中位生存時(shí)間長(zhǎng)于藥物治療組患者。3 SYNTAX積分及Euro積分雙高冠心病高�；颊哌x擇藥物治療發(fā)生不良心血管事件的風(fēng)險(xiǎn)是選擇介入治療的2.416倍。
[Abstract]:Objective: SYNTAX 27 and Euro integral 6 points high high risk of coronary heart disease patients, through the comparison of percutaneous coronary intervention (Percutaneous Coronary Intervention PCI) or the incidence of adverse cardiovascular events after drug treatment, guide the Department of Cardiology clinicians to formulate appropriate individualized treatment strategies in China Syntax integral and Euro integral double high risk of coronary heart disease patients. Methods: a retrospective study from January 2014 to June 2015 Chinese people's Liberation Army Bethune Department of Cardiology Heping Hospital confirmed by coronary angiography of left main disease and (or) three lesions, SYNTAX score of 27 points and 6 points Euro (abbreviation: SE double integral) in 101 cases of coronary heart disease in high-risk patients. According to the different treatment methods were divided into simple. Oral drug treatment group (referred to as: drug treatment group) and PCI group. The patients' medical records, telephone or outpatient follow-up records of patients discharged from hospital The time and type after the occurrence of adverse cardiovascular events. Observation index: 1. major adverse cardiovascular events: the end point of all-cause death, nonfatal myocardial infarction, target vessel revascularization.2. minor adverse cardiovascular end point events: heart failure cardiac readmission, recurrent angina. PCI treatment group and drug treatment group of major adverse cardiovascular the incidence rate of adverse cardiovascular events and minor incidence were calculated to determine the adverse cardiovascular events between the two groups in the incidence of whether there are differences by chi square test, and the adverse cardiovascular events do Kaplan-Meier analysis, no adverse cardiovascular events draw survival curves, Log Rank survival curve (Mantel-Cox) test, and the related regression analysis of risk factors Cox regression. Results: followed up for 1 to 18 months, the drug treatment group had major adverse cardiovascular events (Major Adverse Cardiovascular Events (MACE) 17 cases accounted for 34% in the medical treatment group), group PCI and MACE occurred in 6 patients (PCI group 11.76%), two groups of MACE were statistically significant differences in P=0.008, PCI rate, MACE incidence rate was lower than the drug treatment group. Drug treatment group had heart dysfunction in 21 cases (treatment group accounted for 42%) PCI group, the occurrence of heart dysfunction in 10 cases (PCI group 19.61%), two groups of heart failure incidence was statistically significant, P=0.015, PCI group of heart dysfunction rate is lower than the drug treatment group; drug treatment group had 25 cases of cardiac readmission (accounted for 50% in the medical treatment group), group PCI had cardiogenic readmission in 11 cases (PCI group 21.57%), two groups of cardiac readmission was statistically significant, the incidence rate of P=0.003, PCI group cardiac readmission rate is lower than the drug treatment group; drug treatment group had recurrent angina (21 cases accounted for 42% in the medical treatment group), PCI group had recurrent angina pectoris 9 cases (accounting for PCI 緇，

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