冠状动脉无复流现象患者的术前影响因素及预后  

Prognosis and pre-procedural independent risk factors for patients with no-reflow phenomenon during percutaneous coronary intervention

作　　者：朱升四[1] 周旭晨[1] 刘俊[1] 朱皓[1] 郑晓群[1] 张妍[1] 曲新凯[1] 王俊杰[1] 黄榕翀[1] 

机构地区：[1]大连医科大学附属第一医院心内科,116011

出　　处：《中国医师进修杂志（内科版）》2008年第7期5-8,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨经皮冠状动脉介入（PCI）术中出现无复流现象的术前高危因素及预后。方法回顾性分析2000年1月至2005年1月行PCI治疗并且术中发生无复流现象91例患者（无复流组）的临床资料，随机抽取同期PCI治疗后前向血流正常的103例患者作为对照组。分析两组PCI术前临床资料和术后严重心血管事件的发生率。针对PCI术前临床资料单因素分析中有统计学意义的结果做多因素分析，以判断对无复流现象的预测价值。平均回顾性随访（35．8±15．3）个月。结果无复流组充血性心力衰竭、恶性心律失常、心源性死亡的发生率均高于对照组（P〈0．05）。多因素分析中无复流组患者吸烟指数≥300（OR=2．81，95％CI：1．61～4．38，P=0．007）、术前24h内空腹血糖≥11．1mmol/L（OR=3．39，95％CI：1．51～4．89，P=0．000）、术前1个月内无心绞痛发作（oR=2．39，95％CI：1．22～3．78，P=0．009）是发生无复流现象的危险因素。结论无复流现象提示患者预后差，严重心血管事件明显增加。长期大量吸烟、术前1个月内无心绞痛发作和术前24h内空腹血糖≥11．1mmol/L是无复流现象发生的高危因素。Objective To study the prognosis and pre-procedural independent risk factors for patients with no-reflow （NR） phenomenon during percutaneous coronary intervention （PCI）. Methods Patients with or without NR phenomenon during PCI procedures from January 2000 to January 2005 were studied retrospectively. The clinical data preoperative and the incidence of major adverse cardiovascular events （MACE） between the two groups were compared. Univariate analysis and multivariate Logistic analysis were used to select the risk factors for NR phenomenon. Retrospectively was reviewed for （35.8 ± 15.3） months. Results The NR group had more significant incidence of MACE. Multivariate Logistic analysis showed that the predictive factors for NR were （ 1 ） Smoke index ≥300（OR = 2.81,95%CI： 1.61-4.38 ,P = 0.007）. （2） Fasting blood glucose level before PCI ≥ 11.1 mmol/L （OR = 3.39,95%CI： 1.51-4.89,P = 0.000）. （3） Absence of angina pectoris attack within one month before PCI（OR = 2.39,95%CI： 1.22-3.78, P = 0.009）. Conclusions The prognosis is poor for the PCI patients with NR phenomenon. Those patients whose fasting blood glucose level before PCI ≥ 11.1 mmol/L, smoke index≥ 300 and absence of angina pectoffs attack within one month before PCI have higher incidence of NR phenomenon.

关 键 词：血管成形术 经腔 经皮冠状动脉 预后 无复流现象 

分 类 号：R543.3[医药卫生—心血管疾病] R735.34[医药卫生—内科学]