经皮冠状动脉介入治疗维持性血液透析合并急性冠脉综合征疗效观察  

Clinical observation on percutaneous coronary intervention in maintenance hemodialysis patients with acute coronary syndrome

作　　者：葛香妍 王耿[2] 曹宁[3] 马蕊[2] 周鹤[2] 李智[2] 李根[2] 

机构地区：[1]辽宁中医药大学研究生院,辽宁沈阳110032 [2]沈阳军区总医院心血管内科,辽宁沈阳110016 [3]沈阳军区总医院血液透析科,辽宁沈阳110016

出　　处：《临床军医杂志》2016年第5期488-491,共4页Clinical Journal of Medical Officers

基　　金：辽宁省科技攻关课题(2013225089)

摘　　要：目的探讨经皮冠状动脉介入治疗维持性血液透析(MHD)合并急性冠脉综合征(ACS)的临床疗效。方法选取2008年1月至2014年7月沈阳军区总医院血液透析科收治的100例MHD合并ACS患者,随机分为介入治疗组50例及对照组50例。介入治疗组行经皮冠状动脉介入治疗,术后服用阿司匹林和氯吡格雷行抗血小板治疗;对照组只服用阿司匹林行抗血小板治疗。两组研究终点为1年的患者水平复合终点(Po CE),次要研究终点为患者1年主要出血(TIMI分级)、血栓事件、心脑血管原因再住院次数及心脏超声左心室射血分数(LVEF)。结果所有患者均获得1年随访。两组Po CE发生率比较,差异无统计学意义(P>0.05);介入治疗组患者因心血管事件再住院率明显低于对照组,差异有统计学意义(P<0.05);两组主要出血事件及血栓事件比较,差异无统计学意义(P>0.05);介入治疗组LVEF高于对照组,差异有统计学意义(P<0.05)。结论经皮冠状动脉介入治疗MHD合并ACS,可明显改善症状,减少心绞痛发作及因心血管事件再入院次数,提高患者生存质量,且双联抗血小板治疗未增加主要出血的风险。Objective To explore clinical efficacy of percutaneous coronary intervention （PCI） in patients with acute coronary syn- drome（ACS） who underwent maintenance hemodialysis （MHD）. Methods A total of 100 cases of patients with ACS who underwent MHD were collected in The General Hospital of Shenyang Military Command from January 2008 to July 2014. All the patients were randomly divided into the PCI group and the control group ,50 cases in each group. In the PCI group, dual antiplatelet therapy （DAPT） comprising aspirin and clopidogrel was given after PCI. In the control group, patients received aspirin therapy alone. The primary end point was a composite of endpoint occurring within 1 year. The primary safety and efficacy points were the major bleeding（ TIMI classi- fication） stent thrombosis, any re-hospitalization for cardio-cerebrovascular disease and the value of LVEF. Results All the patients received follow-ups of 1 year. There was no significant difference between the two groups on primary end point（20% versus 21% , P = 0. 680）. The results were statistically significant in the re-hospitalization for eardio-cerebrovascular disease. The rate of readmission was significantly lower（ 50% versus 30% , P = 0. 040 ）. There was no statistically significant difference in total bleeding （6% versus 4% ,P = 0. 740） and thrombotic events between two groups （4% versus 4% , P = 1. 000）. After follow-ups of 1 year, there was no sta- tistically significant value of LVEF between the two groups （ 52% versus 49%, P = 0. 048 ）. Conclusion PCI treatment in patients with MHD combined with ACS can significantly improve the symptoms, reduce the attack of angina pectoris and re-admission number of cardiovascular events, improve life quality of patients without increasing the risk of bleeding or thrombosis.

关 键 词：维持性血液透析 急性冠脉综合症 经皮冠状动脉介入治疗 

分 类 号：R541.4[医药卫生—心血管疾病]