| 幸世峰,张颖,张岳,等.三种治疗方式对早发性冠心病三支病变病人长期生存影响的差异性[J].安徽医药,2020,24(9):1740-1744. |
| 三种治疗方式对早发性冠心病三支病变病人长期生存影响的差异性 |
| The difference of three treatment methods on the long-term survival of patients with three-vessel disease of early-onset coronary heart disease |
| |
| DOI：10.3969/j.issn.1009-6469.2020.09.011 |
| 中文关键词: 冠状动脉疾病 血管成形术，气囊，冠状动脉 冠状动脉分流术 |
| 英文关键词: Coronary artery disease Angioplasty,balloon,coronary Coronary artery bypass |
| 基金项目:新疆维吾尔自治区自然科学基金项目( 2018D01C307) |
|
| 摘要点击次数: 1536 |
| 全文下载次数: 528 |
| 中文摘要: |
| 目的探讨经皮冠状动脉介入治疗( PCI)+药物治疗( MT)、冠状动脉搭桥术( CABG)+MT和单纯 MT三种方式对早发性冠心病三支病变( TVD)病人长期生存影响的差异。方法收集 2009年 1月至 2015年 6月新疆医科大学第五附属医院 597例早发性 TVD病人为研究对象，由临床医师在综合评估病情、指南推荐及病人要求的基础上选择治疗方案， PCI组病人采用 PCI结合药物进行治疗； CABG组病人采用冠脉旁路移植术结合药物进行治疗； MT组病人采用单纯 MT。在完成造影检查后及治疗后，系统性收集所有预后的相关数据，随访后统计分析三种治疗方式的预后差异。结果(1)与单纯 MT组( 20.0%，13.3%， 40.0%，13.3%)比较， PCI组与 CABG组病人的全因死亡率( 5.8%，7.8%)、心源性死亡率( 2.9%，3.9%)、主要心脑血管事件(19.4%，17.6%)及再次血运重建( 5.8%，3.9%)的发生率显著较低( P＜0.05)。(2)生存曲线显示， PCI组与 CABG组的全因死亡率、心源性死亡率差异无统计学意义( P＞0.05)，但均显著低于 MT组( P＜0.05)。(3)对临床变量进行基线资料匹配校正后发现， PCI组与 CABG组的全因死亡率、主要心脑血管事件发生率、心源性死亡率、脑卒中发生率差异无统计学意义( P＞0.05)，但与 CABG相比， PCI会增加心肌梗死及再次行血运重建的风险。与 MT组比较， PCI组的全因死亡率、心源性死亡率、心肌梗死发生率明显较低( P＜0.05)。(4)以危险因素为标准进行亚组分层，结果发现，对冠脉造影评分( SYNTAX)22～32、吸烟、合并心肌梗死病史、糖尿病病史的病人，行 PCI治疗的死亡风险显著低于单纯 MT组( P＜0.05)。对 SYNTAX评分 22～32、合并心肌梗死病史、糖尿病病史的女性病人，行 CABG治疗的死亡风险显著低于 PCI组与 MT组( P＜0.05)。结论整体而言， PCI+MT、 CABG+MT比单纯 MT治疗更能有效改善早发性 TVD病人预后。但合理的早发性 TVD的治疗方案需临床医师结合 SYNTAX评分、病人病史进行个体化分析。 |
| 英文摘要: |
| Objective To explore the effect difference of three treatment methods which are percutaneous coronary intervention(PCI)+ drug therapy(MT)，coronary artery bypass graft(CABG)+ MT and MT alone on the long-term survival of patients with early onset coronary vessel disease(TVD).Methods From January 2009 to June 2015，597 cases of early-onset TVD were collect-ed from the Fifth Affiliated Hospital of Xinjiang Medical University as the research objects.The clinician selected the treatmentplan based on the comprehensive assessment of the condition，the recommendations of the guidelines and the patient’s require- ments，PCI patients were treated with PCI combined with drugs；CABG patients were treated with coronary bypass grafting com- bined with drugs；MT patients were treated with MT alone.All prognostic data were collected systematically after angiographic exam-ination and treatment，and the prognostic differences of the three treatments were analyzed statistically after follow-up.Results(1) Compared with MT group(20.0%，13.3%，40.0%，13.3%)，the incidence of all-cause mortality(5.8%，7.8%)，cardiogenic mortality(2.9%，3.9%)， major cardiovascular and cerebrovascular events(19.4%，17.6%) and the incidence of revascularization(5.8%，3.9%)in PCI group and CABG group were significantly lower(P＜0.05)(.2)There was no significant difference in all-cause mortal- ity and cardiogenic mortality between PCI group and CABG group，but they were significantly lower than MT group(P＜0.05)(.3) There was no significant difference in all-cause mortality，incidence of major cardiovascular and cerebrovascular events，cardiogenic mortality and incidence of stroke between PCI group and CABG group(P＞0.05)，but compared with CABG，PCI increased the risk of myocardial infarction and revascularization.Compared with MT group，all-cause mortality，cardiogenic mortality and incidence of myocardial infarction in PCI group were significantly lower(P＜0.05)(.4)For patients with SYNTAX score 22-32，smoking，myo- cardial infarction and diabetes mellitus，the mortality risk of PCI was lower than that of MT group(P＜0.05).The death risk of CABG treatment was significantly lower in women with SYNTAX score 22-32，history of myocardial infarction and diabetes than in PCI and MT groups(P＜0.05).Conclusion Overall，PCI+MT and CABG+MT are more effective than MT alone in improving the prognosis of early-onset TVD patients.However，a reasonable treatment plan for early onset TVD requires individualized analysis byclinicians combined with SYNTAX score and patient history. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
