老年冠心病患者冠状动脉旁路移植术后再发心绞痛的介入治疗疗效  

Effect of PCI on recurrent angina pectoris in CHD patients after coronary bypass

作　　者：邓玉婷[1] 张纯全[1] 刘玉昊[1] 王旭[1] 

机构地区：[1]青岛大学医学院附属青岛市市立医院东院心内科,266071

出　　处：《中华老年心脑血管病杂志》2015年第10期1044-1047,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的观察老年冠心病患者冠状动脉旁路移植术后再发心绞痛给予PCI近期的神经内分泌及心功能变化。方法收集行冠状动脉旁路移植术后再发心绞痛患者44例,根据是否行PCI分为PCI组23例,给予优化药物+冠状动脉旁路血管或者原位血管PCI,药物组21例,给予优化药物治疗。2组患者分别在入院时及治疗3个月后抽静脉血及心脏超声检查,检测各神经内分泌因素水平及心脏功能。结果与药物组比较,PCI组治疗后肾素活性、血管紧张素Ⅱ、醛固酮、去甲肾上腺素、肾上腺素水平明显降低[(2.70±0.31)μg/(L·h)vs(3.40±0.42)μg/(L·h),(155.32±11.70)ng/L vs(173.38±11.47)ng/L,(161.11±10.64)pmol/L vs(173.85±9.69)pmol/L,(2815.28±295.40)pmol/Lvs(3462.82±487.51)pmol/L,(532.81±115.32)pmol/Lvs(633.41±60.47)pmol/L,P<0.05],左心室舒张末内径明显缩小(P<0.01),LVEF显著升高(P<0.01)。相关分析显示,B型钠尿肽与各神经内分泌因子水平呈正相关,LVEF与各神经内分泌因子水平呈负相关(P<0.01)。结论老年患者冠状动脉旁路移植术后再发心绞痛行PCI近期疗效显著优于单纯优化药物治疗。Objective To analyze the effect of PCI on recurrent angina pectoris in CHD patients after coronary bypass by observing the changes of their neuroendocrine and cardiac function.Methods Forty-four patients with recurrent angina pectoris who underwent coronary bypass in our hospital were divided into PCI treatment group（n=23）and drug treatment group（n=21）.The patients in PCI treatment group were treated with drugs plus coronary bypass or in situ PCI and those in drug treatment group were treated only with drugs.Their serum neuroendocrine factor level was measured and their cardiac function was assayed at admission and 3 months after treatment.Results The renin activity and serum levels of angiotensin Ⅱ,aldosterone,norepinephrine,adrenaline were significantly lower in PCI treatment group than in drug treatment group3 months after treatment（P〈0.05）.The inner diameter of left ventricle at the end diastolic phase was significantly shorter and the LVEF was significantly higher in PCI treatment group than in drug treatment group 3months after treatment（P〈0.01）.Correlation analysis showed that the serum BNP level was positively related with the neuroendocrine factor level while the LVEF was negatively related with the neuroendocrine factor level（P〈0.01）.Conclusion The short-term effect of PCI is much better than that of drugs on recurrent angina pectoris in elderly CHD patients after coronary bypass.

关 键 词：冠心病 冠状动脉分流术 心绞痛 血管紧张素Ⅱ 

分 类 号：R541.4[医药卫生—心血管疾病]