本文選題：冠心病 + 三支病變��； 參考：《華中科技大學(xué)學(xué)報(bào)(醫(yī)學(xué)版)》2017年06期

【摘要】：目的探討冠心病三支病變(three-vessel disease,TVD)預(yù)后不良患者的臨床特點(diǎn),以及經(jīng)皮冠狀動(dòng)脈介入術(shù)(PCI)、冠狀動(dòng)脈旁路移植術(shù)(CABG)和單純藥物治療等3種治療方式對(duì)遠(yuǎn)期預(yù)后的影響,以期為臨床治療策略提供參考。方法連續(xù)入組2004年4月至2011年2月在阜外醫(yī)院入院的TVD患者8 943例。對(duì)所收集的TVD患者大樣本隨訪得到的1年主要心腦血管不良事件(major adverse cardiovascular and cerebrovascular events,MACCE)組和非MACCE組進(jìn)行臨床因素和治療策略對(duì)比分析。結(jié)果與非MACCE組相比,MACCE組年齡更大、心腎功能更差、合并癥包括糖尿病、卒中等更多,冠脈病變更復(fù)雜。校正多因素后,血肌酐水平、出院帶藥阿司匹林獨(dú)立影響MACCE。MACCE組和非MACCE組患者治療策略存在明顯差異(P0.01)。MACCE組血運(yùn)重建顯著少于非MACCE組(64.9%vs.76.2%,P0.01),其中PCI組間無(wú)差異(46.1%vs.46.2%,P=0.533);差異來(lái)自MACCE組CABG顯著少于非MACCE組(18.8%vs.30.0%,P0.01),而單純藥物治療顯著多于非MACCE組(35.1%vs.23.8%,P0.01)。結(jié)論腎功能和服用阿司匹林是TVD患者心腦血管不良事件的獨(dú)立影響因素。非MACCE組患者血運(yùn)重建要顯著多于MACCE組患者。血運(yùn)重建可能是改善TVD患者預(yù)后的重要因素。
[Abstract]:Objective to investigate the clinical characteristics of patients with poor prognosis of three-vessel disease with coronary artery disease (three-vessel disease), and the effects of three methods of percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABGG) and drug therapy on the long-term prognosis.In order to provide reference for clinical treatment strategy.Methods from April 2004 to February 2011, 8 943 TVD patients were admitted to Fuwei Hospital.The clinical factors and treatment strategies of major adverse cardiovascular and cerebrovascular events (Macce) group and non- group were compared and analyzed in a large sample of TVD patients who were followed up for one year.Results compared with the control group, MACCE group was older and worse in heart and kidney function. The complications included diabetes mellitus, more stroke and more complicated coronary artery disease.After adjusting for multiple factors, serum creatinine levels,There were significant differences in treatment strategies between the MACCE.MACCE group and the non MACCE group. There was a significant difference between the two groups. There was a significant difference in blood revascularization between the two groups (P0.01n. MACCE group was significantly lower than that in the non- group (64.9vs.76.2cm). There was no significant difference between the PCI group (46.1vs.46.2vs.46.2p0.533); the difference was between the MACCE group and the non- group (18.8vs.30.0P0.01g), and the difference was significantly lower than that in the non- group (18.8vs.30.01g).The pure drug therapy was significantly more than that in the non-MACCE group (35. 1% vs 23. 8% P 0. 01).Conclusion Renal function and aspirin are independent factors of cardiovascular and cerebrovascular adverse events in TVD patients.Revascularization in non-MACCE group was significantly more than that in MACCE group.Revascularization may be an important factor in improving the prognosis of TVD patients.
【作者單位】： 中國(guó)醫(yī)學(xué)科學(xué)院北京協(xié)和醫(yī)學(xué)院阜外醫(yī)院國(guó)家心臟病中心;
【基金】：國(guó)家重點(diǎn)基礎(chǔ)研究發(fā)展計(jì)劃資助項(xiàng)目(No.2010CB732601) 國(guó)家高技術(shù)研究發(fā)展計(jì)劃資助項(xiàng)目(No.2015AA020407) 國(guó)家自然科學(xué)基金資助項(xiàng)目(No.81470380) 國(guó)家科技支撐計(jì)劃資助項(xiàng)目(No.2016YFC1301301) 中國(guó)醫(yī)學(xué)科學(xué)院醫(yī)學(xué)與健康科技創(chuàng)新工程資助項(xiàng)目(No.2016-I2M-1-002)
【分類號(hào)】：R541.4
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本文編號(hào)：1765081