本文選題：冠心病　切入點：三支病變　出處：《濟南大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:研究冠心病患者開展冠狀動脈造影(CAG)檢查顯示冠狀動脈(冠脈)的三支血管出現(xiàn)病變(TVD)(無左主干病變),接受以下三種不同治療方案即經(jīng)皮冠狀動脈介入治療(PCI,PCI組)、單純的藥物治療組(藥物組)及冠狀動脈旁路移植術(CABG,CABG組)的預后,以及預后與危險因素之間的關系。方法:回顧性連續(xù)性收集560例于2012年1月到2016年1月間入濟南市第四人民醫(yī)院開展CAG檢查示為無左主干的TVD冠心病患者,進行隨訪的年限大約為1~4年,共510例患者進行了有效的隨訪,隨訪的成功率在98.0%。病例按治療方案不同分為藥物組(n=116),PCI組(n=274),及CABG組(n=120),又根據(jù)是否完全性血運重建將PCI組患者又分成完全組及不完全組。主要隨訪發(fā)生的不良的心腦血管事件(MACCE),其包括:再次冠脈血運重建、心源性死亡、腦卒中及再發(fā)性心肌梗死。開展三種治療方案的預后比較,然后再將不同組患者的MACCE發(fā)生率與臨床的資料進行回歸性分析,從而得出MACCE率的獨立性的危險因素。結果:1.不同治療方案組的預后的比較,藥物組的MACCE率、再發(fā)性心肌梗死率、心源性死亡率均高于CABG組及PCI組(P0.05),而腦卒中率與CABG組無差異(P0.05),而高于PCI組(P0.05)。PCI組在再次冠脈血運重建率、MACCE率、再發(fā)性心肌梗死率以及心源性死亡率方面高于CABG組(P0.05),腦卒中率CABG高于PCI組(P0.05)。然后再根據(jù)SYNTAX積分低(0-22分)、中(23-32分)及高(≥33分)三組分別比較三組的MACCE率。低SYNTAX積分組PCI組、藥物組及CABG組在心源性死亡率、MACCE率、再發(fā)性的心肌梗死率,以及CABG組和PCI組在再次冠脈血運重建率,上述均無統(tǒng)計學差異(P0.05),而在腦卒中率CABG組高于PCI組與藥物組(P0.05)。中SYNTAX積分組藥物組在再發(fā)性心肌梗死率、心源性死亡率、MACCE及腦卒中率均高于CABG組及PCI組(P0.05)。而PCI組在心源性死亡率、MACCE率、再次冠脈血運重建率及再發(fā)性心肌梗死率比較高于CABG組,均有統(tǒng)計學意(P0.05)。高SYNTAX積分方面在MACCE率、心源性死亡率及再發(fā)性心肌梗死率方面,而CABG最低,PCI組居中,藥物組最高,均有統(tǒng)計學意義(P0.05),而CABG組在再次冠脈血運重建低于PCI組,有統(tǒng)計學差異(P0.05)。藥物組在腦卒中與CABG組及PCI組的比較三組間均無明顯差異(P0.05)。回歸性分析顯示藥物組最低,PCI組次之及CABG組生存率最高。2.PCI治療不完全組在再次冠脈血運重建率、MACCE率、再發(fā)性心肌梗死率及心源性死亡率高于完全組,上述有統(tǒng)計學差異(P0.05),而腦卒中率無統(tǒng)計學差異(P0.05)�；貧w性分析顯示PCI治療完全組生存率高于不完全性組。3.高脂血癥史、身高體重指數(shù)(BMI)、年齡、急性心肌梗死、貧困、糖尿病病史、高血壓病史、吸煙史、心血管病史、血甘油三酯(TG)、血膽固醇(TC)、左室的射血分數(shù)(LVEF)、低密度脂蛋白(LDL-C)、冠狀動脈慢性閉塞性(CTO)病變及SYNTAX是MACCE發(fā)生率的獨立性的危險因素,其中糖尿病病史及高血壓病史影響較為明顯。結論:1.無左主干TVD冠心病患者在總的預后比較藥物治療效果差,CABG治療效果較好,PCI治療居中。而在SYNTAX低積分組,PCI治療、藥物組及CABG治療的預后無明顯差異,而在SYNTAX中、高積分組,藥物組預后差,CABG組預后最好及PCI組預后居中。據(jù)生存分析示不同治療方案為MACCE率的獨立性危險因素。2.PCI組中不完全組的CTO病變、急性心肌梗死及高SYNTAX積分的比例叫高于完全組。完全組的MACCE發(fā)生率低及生存率高,據(jù)生存分析示血運重建不完全為MACCE率的獨立性危險因素。3.急性心肌梗死、高脂血癥史、BMI、年齡、貧困、吸煙史、糖尿病病史、高血壓病史、心血管病史、CTO病變、LVEF、SYNTAX、TG、TC及LDL-C為MACCE率的獨立性的危險因素,其中糖尿病及高血壓病史影響較為明顯。
[Abstract]:Objective: To study the development of coronary angiography in patients with coronary heart disease (CAG) coronary angiography (CAG) showed three vessel lesions (TVD) (left main lesion), accept the following three different treatment regimens with percutaneous coronary intervention (PCI, group PCI), single drug treatment group (drug group) and coronary artery bypass grafting (CABG group CABG) prognosis, and the relationship between the prognosis and risk factors. Methods: We retrospectively collected 560 cases of continuity from January 2012 to January 2016 in the Fourth People's Hospital of Ji'nan city to carry out CAG examination showed no TVD left main coronary heart disease patients, follow-up period about 1~4 years, a total of 510 patients were effective follow-up, follow-up success rate in 98.0%. patients according to the different treatment were divided into drug group (n=116), PCI group (n=274), and CABG group (n=120), according to whether the complete revascularization group PCI patients Divided into group and incomplete follow-up group. Main adverse cardiovascular events (MACCE), including: revascularization, cardiac death, stroke and recurrent myocardial infarction. The prognosis of three to carry out treatment, then compare the different groups of patients with MACCE incidence and clinical the data regression analysis, thus obtains the independent risk factor of MACCE rate. Results: compared with the prognosis of 1. different treatment group, drug group MACCE rate, recurrent myocardial infarction, cardiac mortality was higher than that of CABG group and PCI group (P0.05), and stroke rate and CABG group no difference (P0.05), and higher than that of group PCI (P0.05).PCI group in the revascularization rate, MACCE rate, recurrent myocardial infarction and cardiogenic mortality rate is higher than that of CABG group (P0.05), stroke rate of CABG is higher than that of PCI group (P0.05). Then according to the SYNTAX score low (0-22 鍒，

本文編號：1623940