冠状动脉三支病变糖尿病患者介入治疗和冠脉搭桥长期疗效对比研究  

Comparative effectiveness of PCI and CABG in patients with multivessel diseases and diabetes

作　　者：宿文荣 张俊刚[2] 伦增瑞[2] 王健[2] 王曙光[2] 王国栋[2] 陈彦波[2] 吴海军[2] 郑建伟[2] 张爱元[2] 

机构地区：[1]青岛经济技术开发区第一人民医院,山东青岛266555 [2]潍坊市人民医院,山东潍坊261041

出　　处：《中国现代医学杂志》2015年第10期92-95,共4页China Journal of Modern Medicine

摘　　要：目的比较冠脉支架(PCI)和搭桥(CABG)对冠心病合并糖尿病患者术后3年的死亡率、再入院率、心功能和不良事件发生率。方法随访2008-2010年冠脉造影结果示三支病变糖尿病患者,入选患者267例,失访29例,随访238例,随访率为89.14%。在内科介入医师和冠脉搭桥手术医师指导和建议下,根据患者意愿选择治疗方式,将其分为PCI组(120例)和CABG组(118例)。比较两组的死亡率、再入院率、再发心肌梗死率、再发脑卒中率、再次血运重建率,以及术后心功能情况。结果 CABG组术后1年(0.85%)死亡率明显低于PCI组(5.83%),差异有统计学意义(P=0.033);术后3年死亡率(CABG 11.02%vs PCI 17.50%,P=0.153),差异无统计学意义(P>0.05)。再发心肌梗死率术后1和3年,CABG组(0.00%,4.80%)均明显低于PCI组(4.00%,15.20%),差异有统计学意义(P<0.05);再入院率,术后1年,PCI组(16.20%)明显高于CABG组(6.70%),差异有统计学意义,术后3年(PCI 46.50%vs CABG 35.20%,P=0.103,P>0.05),差异无统计学意义;再次血运重建率术后1和3年,PCI组(14.10%,28.30%)均明显高于CABG组(1.00%,7.60%),差异有统计学意义(P=0.001);再发脑卒中率,术后1和3年(PCI 2.00%,10.10%vs CABG 0.00%,5.70%),两组比较差异无统计学意义(P>0.05)。术后1年CABG组(69.20%)心功能改善较PCI组(54.00%)明显,差异有统计学意义(P=0.017),术后3年两组(PCI 82.80%vs CABG 91.40%)比较,差异无统计学意义(P=0.066)。结论冠状动脉三支病变糖尿病患者PCI术后1年死亡率和再入院率明显高于CABG患者,术后3年无明显差异。术后1和3年的再发心肌梗死率和再次血运重建率PCI组均明显高于CABG组。再发脑卒中率,术后1和3年,两组比较均无明显差异。CABG组术后1年的心功能改善率较PCI组明显,术后3年无明显差别。[ Objective ] To compare the mortality, re-admission rate, incidence of cardiac adverse events at 3- year after operation in patients with muhivessel disease and type 2 diabetes treated by percutaneous coronary intervention （PCI） and coronary artery bypass grafting （CABG）. [Methods] A total of 267 patients who suffered from diabetes and had been diagnosed as multivessel disease by coronary artery angiography from 2008 to 2010 were selected. Twenty-nine patients were lost to follow-up and the rate of follow-up was 89.14%. Under the guidence of doctors of medical intervention and coronary artery bypass graft surgery, the patients were divided into PCI group （n =120） and CABG group （n = 118） according to their own willing. The mortality, heart function, the rate of re-admission, reinfarction, stroke, and repeat revascularization of the two groups were compared. [ Results ] One-year motality after operations of CABG group （0.85%） was significantly lower than that of PCI group （5.83%） （P = 0.033）. Three-year mortality between two groups was not statistically different （P = 0.153）. Re-myocardial infarction rates 1 and 3 years after operation of CABG group were significantly lower than those of PCI group （PCI 4.00%, 15.20% vs CABG 0.00%, 4.80%, P 〈 0.05）. One year after operation, re-admission rate was significantly higher in PCI group than in CABG group （PCI 16.20% vs CABG 6.70%, P = 0.032）, and 3 years after operation, there was not statistical significantly different between two groups （PCI 46.50% vs CAGB 35.20%, P = 0.103）. Revascularization rates 1 and 3 years after operation （PCI 14.10%, 28.30% vs CAGB 1.00%, 7.60%, P = 0.001） were elevated significantly in PCI group. Stroke rates 1 and 3 years after operation （PCI 2.00%, 10.10% vs CABG 0.00%, 5.70%, P 〉 0.05） were not significantly different between two treatment groups. The improvement of heart function was significantly obvious in CABG group than in PCI one at 1-year after operation （CABG 69.20% vs PCI

关 键 词：冠脉搭桥 介入治疗 心肌梗死 糖尿病 

分 类 号：R542.22[医药卫生—心血管疾病]