發(fā)布時(shí)間：2019-01-02 19:18

【摘要】：目的:觀察廣西醫(yī)科大學(xué)第一附屬醫(yī)院西院心血管內(nèi)科PCI相關(guān)心肌梗死的發(fā)生率及危險(xiǎn)因素,為PCI相關(guān)心肌梗死的防治提供一定的臨床參考。方法:符合入組條件276例術(shù)前cTn I正常的患者擇期行經(jīng)皮冠狀動(dòng)脈介入治療(PCI)術(shù),根據(jù)術(shù)后48h內(nèi)肌鈣蛋白I(cTnI)檢測(cè)值分為三組,I組(cTnI正常組,cTnI≤0.033 ng/mL,167例);II組(PCI相關(guān)心肌損傷組,0.033 ng/mLcTnI≤0.165 ng/mL,51例);III組(PCI相關(guān)心肌梗死組,cTnI0.165ng/mL,58例)。通過(guò)對(duì)三組患者術(shù)前一般臨床資料、血生化指標(biāo)、冠脈造影特點(diǎn)及PCI術(shù)中操作參數(shù)指標(biāo)等因素進(jìn)行觀察比較,利用Logistic回歸分析PCI相關(guān)心肌梗死的重要危險(xiǎn)因素。術(shù)后6-24個(gè)月隨訪,比較PCI術(shù)后MACE發(fā)生率。結(jié)果:276例擇期PCI患者中,術(shù)后c TnI在正常范圍內(nèi)患者有167例(60.50%),cTn I超過(guò)正常值上限但小于5倍患者有51例(18.47%),cTnI超過(guò)正常值上限5倍患者有58例(21.01%)。與I組對(duì)比,II組、III組患者術(shù)前hs-CRP[(1.21±0.56)vs(2.22±0.83)vs(3.66±1.39)mg/L,P0.001]差異有統(tǒng)計(jì)學(xué)意義,且cTnI與hs-CRP呈正相關(guān);II組、III組中多支血管病變(39.53%vs 64.71%vs 75.86%,P0.001),C型血管病變(47.90%vs 56.86%vs 74.14%,P0.001)患者所占比率要高于I組;比較三組患者PCI術(shù)中操作參數(shù):發(fā)現(xiàn)I組與II組及III組在支架數(shù)目[(1.14±0.35)vs(1.27±0.45)vs(1.55±0.56)個(gè),P0.001]、支架總長(zhǎng)度[(30.16±14.27)vs(35.94±14.23)vs(38.68±17.10)mm,P=0.042]、球囊總個(gè)數(shù)[(2.03±0.52)vs(2.39±0.14)vs(3.12±1.18)個(gè),P=0.002]、囊擴(kuò)張最大壓力[(13.62±4.46)vs(14.58±4.36)vs(15.67±3.18)atm,P=0.042]方面比較,三者間差異均有統(tǒng)計(jì)學(xué)意義;Logistic回歸分析結(jié)果顯示,hs-CRP、支架總長(zhǎng)度、多枚支架植入、C型血管病變是PCI相關(guān)心肌梗死的重要危險(xiǎn)因素。術(shù)后6-24個(gè)月隨訪,發(fā)現(xiàn)I組中有3例患者發(fā)生MACE(2例心力衰竭,1例再次行TVR),II組中有4例患者發(fā)生MACE(1例心力衰竭,1例再發(fā)急性心肌梗死,2例再次行TVR),III組中有2例患者發(fā)生MACE(1例心力衰竭,1例再發(fā)急性心肌梗死),三組患者短期MACE發(fā)生率(1.80%vs 7.84%vs 3.45%,P=0.103)比較,差異無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論:1、我院西院心血管內(nèi)科PCI相關(guān)心肌損傷發(fā)生率為18.47%,PCI相關(guān)心肌梗死發(fā)生率為21.01%;2、hs-CRP、支架總長(zhǎng)度、多枚支架植入、C型血管病變是PCI相關(guān)心肌梗死的重要危險(xiǎn)因素;3、術(shù)后6-24個(gè)月隨訪,PCI相關(guān)心肌梗死并不增加患者M(jìn)ACE發(fā)生率。
[Abstract]:Objective: to observe the incidence and risk factors of PCI related myocardial infarction in the Department of Cardiovascular Medicine, West Hospital, first affiliated Hospital of Guangxi Medical University, and to provide some clinical reference for the prevention and treatment of PCI related myocardial infarction. Methods: 276 patients with normal cTn I before operation underwent percutaneous coronary intervention (PCI). According to the values of cardiac troponin I (cTnI) in 48 hours after operation, they were divided into three groups: group I (cTnI normal group, cTnI 鈮，

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