| 孟培娜,吴志明,尤威,等.经皮冠状动脉介入相关心肌损伤的危险因素分析[J].安徽医药,2016,20(10):1895-1899. |
| 经皮冠状动脉介入相关心肌损伤的危险因素分析 |
| Risk factors of myocardial injury during the perioperative period of percutaneous coronary intervention |
| 投稿时间：2016-04-25 |
| DOI： |
| 中文关键词: 冠状动脉粥样硬化性心脏病 经皮冠状动脉介入围术期心肌损伤 危险因素 |
| 英文关键词: Coronary heart disease Percutaneous coronary intervention perioperative myocardial injury Risk factors |
| 基金项目: |
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| 中文摘要: |
| 目的 探讨经皮冠状动脉介入(PCI)相关心肌损伤的危险因素。方法 146例冠心病患者行冠脉造影+经皮冠脉支架植入术,依据术后24 h内心肌肌钙蛋白I(cTnI)最大值分为三组,第一组(18例):PCI术后cTnI在正常范围内(cTnI<0.04 μg·L-1)组；第二组(44例):正常上限≤cTnI<正常上限5倍(0.04 μg·L-1≤cTnI<0.2 μg·L-1)；第三组(84例):cTnI≥正常上限的5倍(cTnI≥0.2μg·L-1)；通过分析患者临床基础特点及血清学指标检测、冠脉病变及手术过程等因素,分析PCI围术期心肌损伤的危险因素。结果 (1)三组患者的年龄、性别、既往PCI术史、高血压病史、糖尿病史、吸烟史、他汀类药物服用史以及高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、载脂蛋白B(apo-B)、左室射血分数(LVEF)等指标上差异无统计学意义,但术前超敏C反应蛋白(hs-CRP)差异有统计学意义,且随着术前数值的升高,术后cTnI数值越高；(2)术中参数提示:支架总长度[(44.78±15.57) vs(44.64±23.73) vs(58.43±27.66) mm,P=0.006]、最大支架直径[(3.31±0.51) vs(3.35±0.43) vs(3.15±0.44) mm,P=0.039]、球囊个数[(2.00±1.09) vs(2.27±1.44) vs(3.10±1.47)个,P=0.001]、支架平均释放压力[(8.22±1.48) vs(9.91±1.79) vs(12.40±1.53) atm,P<0.001]以及单支病变比例(55.6% vs 27.3% vs 19.0%,P=0.006)在三组比较差异有统计学意义,单支病变在第一组中比例最高,第三组中比例最低；随着术中支架长度的增加,支架平均释放压力的增大以及球囊使用的增多,术后cTnI数值越高；(3)依据PCI术后cTnI是否超过5倍正常上限水平,将患者分为两组,通过Logistic回归分析,结果提示hs-CRP(OR 9.359,5% CI:3.589,4.402,P<0.001)、支架总长度 (OR 1.043,5% CI:1.009,1.078,P=0.012) 以及支架平均释放压力(OR 4.124,5% CI:2.024,8.403,P<0.001)是PCI围术期心肌损伤的危险因素。结论 hs-CRP、支架总长度以及支架平均释放压力是PCI围术期心肌损伤的危险因素,若能通过术前检测患者的基础临床特点尤其是hs-CRP,以及术中注意调控操作参数,有望预测并减少PCI围术期心肌损伤的发生率。 |
| 英文摘要: |
| Objective To investigate the risk factors of myocardial injury during the perioperative period of percutaneous coronary intervention.Methods 146 PCI cases were assigned into three groups in terms of the highest level of cTnI in 24 h after PCI:in the first group,cTnI was within the normal level (18 cases,cTnI<0.04 μg·L-1);in the second group,cTnI was within the range between the normal upper limit and five times normal upper limit (44 cases,0.04 μg·L-1≤cTnI<0.2 μg·L-1);in the third group,cTnI was higher than 5 times the normal upper limit (84 cases,cTnI≥0.2 μg·L-1).We investigated the baseline clinical,laboratorial,angiographic and procedural data,and analyzed the risk factors of myocardial injury during the perioperative period of percutaneous coronary intervention.Results There were no significant differences in baseline clinical characteristics among the three groups,including age,gender,history of PCI,hypertention,diabetes,smoking,statins intake and HDL-C,LDL-C,apo-B,LVEF,but there was significant difference in hs-CRP level among three groups and postoperative cTnI increased with the increase of preoperative level.There were statistically significant differences in total stent length (44.78±15.57 vs 44.64±23.73 vs 58.43±27.66 mm,P=0.006),maximum stent diameter (3.31±0.51 vs 3.35±0.43 vs 3.15±0.44 mm, P=0.039),in-stent expansion pressure (8.22±1.48 vs 9.91±1.79 vs 12.40±1.53 atm,P<0.001),numbers of balloons (2.00±1.09 vs 2.27±1.44 vs 3.10±1.47,P=0.001) and ratio of single coronary lesion (55.6% vs 27.3% vs 19.0%,P=0.006) among three groups.And as total stent length,in-stent expansion pressure,and numbers of balloons raised,cTnI relatively increased.Result of logistic analysis showed that hs-CRP(OR 9.359,5% CI:3.589,24.402,P<0.001),totle stent length (OR 1.043,5% CI:1.009,1.078,P=0.012) and in-stent expansion pressure(OR 4.124,5% CI:2.024,8.403,P<0.001)were risk factors of myocardial injury.Conclusions Hs-CRP,total stent length and in-stent expansion pressure were risk factors of myocardial injury during the perioperative period of PCI.If baseline clinical characteristics especially hs-CRP could be estimated before coronary angiography and the operative parameters could be regulated,it is likely to predict and decrease the incidence of myocardial injury during perioperative period of PCI. |
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