老年性糖尿病合并冠心病患者PTCA+支架植入术严重并发症分析  

Vital complications of PTCA and stenting in aged diabetic and nondiabetic patients with coronary heart disease: a report from the hospitalized review study of clinical investigators

作　　者：王旭开[1] 杨成明[1] 王红勇[1] 付春江[1] 方玉强[1] 石伟彬[1] 张晔[1] 严景恩[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所心血管内科,重庆400042

出　　处：《重庆医学》2004年第10期1503-1505,共3页Chongqing medicine

基　　金：国家自然基金课题资助项目 (30 1 70 384)

摘　　要：目的　总结老年性糖尿病和非糖尿病合并冠心病患者的冠状动脉病变特征、PTCA治疗结果和预后情况 ,探讨血管性介入术后严重并发症的特征和不同点。方法　我院 1998年 5月～ 2 0 0 3年 12月间共收治 2 0 2例急性冠脉综合征患者 ,其中 5 7例是老年性糖尿病组 ,另外从同期的非糖尿病老年冠心病患者中抽出同样本数量的对照组 ,均完成PTCA支架治疗。进行回顾性对照研究。结果　术后老年性糖尿病组出现严重并发症 2 2例 ,发生率以病例数计为 39% (2 2例 / 5 7例 ) ,其中ARDS 2例、腹膜后及肾包膜下血肿 2例、急性脑出血 3例、肺栓塞 2例、迷走反射 8例、支架远端急性闭塞 1例、术后低血压状态 2例、急性肾功能不全 2例。而对照组仅有迷走反射 2例和术后低血压状态 2例。结论　老年性糖尿病合并冠心病患者血管性介入诊疗术后可出现一些严重并发症 ,一旦发生 ,可引起严重后果。由于其病变复杂 ,手术难度大 ,住院期间死亡率和后期的症状复发率都较高。尤其要注意术后并发症的预兆 ,只要评估正确 ,处理及时 ,老年性糖尿病合并冠心病患者的介入治疗仍是优于单纯药物治疗的方法。Objective To make a summary of the coronary culprit lesions characteristics in the aged diabets and non-diabetic patients with PTCA interventions,and to explore the difference of the vital complications after coronary interventions between these two groups.Methods Over 64 months retrospective study starting in August 1998,202 patients with acute coronary syndrome in our hospital were recruited. Fifty-seven cases were the aged diabet patients undergone PTCA and stenting, of whom were classification of diabetic group. Also the same number of non-diabetic old patients admitted at the same period was selected as the control group, undergone PTCA and stenting too.Results A total of 22 cases with vital complications (total ratio was 39%) after percutaneous coronary interventions (PCI) were recorded in the aged diabetes group. Among the groups 2 cases were involved with adult respiratory distress syndrome (ARDS), 2 cases with retroperitoneal and intro-envelope of kidney hematoma,3 cases with acute cerebral hemohrrages;3 cases with pulmonary artery thrombo emblolism and 8 cases with vagal stimulation reflux(included 3 cases in the control group), 4 cases happened with the hypotension after the PTCA procedure (2 cases were in control group),and 2 cases got acute renal dysfunction.Conclusion The PCI management in the aged diabetic patients with coronary heart disease may occur serious complications leading dangerous outcome. Due to the complex culprit lesions, the mortality and restenosis of in-hospital were higher than the control group. So we should pay attention to any foreboding signs of the vital complications. Only by the correct evaluations and recognition, PCI regimen still be superiority to the non-interventional treatment.

关 键 词：老年人 糖尿病 冠状动脉疾病 血管成形术 并发症 

分 类 号：R587.1[医药卫生—内分泌] R541.4[医药卫生—内科学]