腹主动脉瘤合并冠心病患者三种治疗策略疗效分析  

Efficacy of three different strategies for patients with abdominal aortic aneurysm coexisting with coronary artery disease

作　　者：李威[1] 罗淞元[2] 刘媛[2] 罗建方 黄文晖[2] 陈纪言[2] LI Wei LUO Songyuan LIU Yuan LUO Jianfang HUANG Wenhui CHEN Jiyan(Southern Medical University, Guangzhou 510515, China)

机构地区：[1]南方医科大学,广州510515 [2]广东省心血管病研究所-广东省人民医院广东省医学科学院

出　　处：《心肺血管病杂志》2016年第10期783-787,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:分析不同手术治疗策略对合并有严重冠心病且适合行腔内修复术(EVAR)的腹主动脉瘤(AAA)患者住院期间预后的的影响。方法:采用回顾性分析2005年1月至2013年12月间,在广东省人民医院住院50岁以上确诊AAA并行冠状动脉造影的患者207例,收集临床及影像学资料,探讨AAA患者中冠心病的检出率。进一步分析合并有严重冠心病且适合行EVAR的AAA患者,根据不同手术治疗策略,分为同期EVAR+经皮冠状动脉介入治疗(PCI)组、EVAR后PCI组、PCI后EVAR组,分析不同分组患者住院期间术后不良事件发生的情况。结果:207例50岁以上AAA患者中,经冠状动脉造影确诊冠心病151例(72.9%)。93例合并有严重冠心病且适合行EVAR的AAA患者中,同期EVAR+PCI组6例(6.5%),EVAR后PCI组60例(64.5%),PCI后EVAR组27例(29.0%)。各组间年龄、性别、动脉粥样硬化危险因素、冠状动脉病变支数情况及AAA最大径等无统计学差异(P均>0.05)。同期EVAR+PCI组中,无发生住院期间死亡,EVAR后PCI组出现1例(1.7%),PCI后EVAR组出现2例(7.4%),各组间住院期间病死率差异无统计学意义。同期EVAR+PCI组出现1例(16.7%)术后并发症,EVAR后PCI组10例(16.7%),PCI后EVAR组3例(11.1%),各组住院期间术后并发症发生率无统计学差异。结论:50岁以上AAA患者中有着较高的冠心病共患率。对于合并有严重冠心病且适合行EVAR的AAA患者,同期行EVAR+PCI术并不会增加术后住院期间不良事件的发生。Objective：To evaluate the impact of different intervention strategies for patients with ab- dominal aortic aneurysm （AAA） suitable for endovascular aortic repair （EYAR） coexisting with severe coro- nary artery disease （CAD） on early prognosis in hospital. Methods： A retrospective review of the records of 207 consecutive patients（ 〉 50 years） with AAA who underwent coronary angiography in Guangdong General Hospital between Jan 2005 and Dec 2013 was carried out. Clinical and imaging data was collected to explore the prevalence of CAD in patients with AAA. According to different intervention strategies, patients with AAA suit- able for EVAR coexisting with severe CAD were divided into three groups： one-stage EVAR（ endovascular aortic repair） ＋ PCI（ percutaneous coronary intervention） group, EVAR followed by PCI group and PCI followed by EVAR group. The impact of different intervention strategies for AAA suitable for EVAR coexisting with severe CAD on early prognosis in hospital was analyzed. Results： Of the 207 patients （ 〉 50 years） with AAA, CAD was diagnosed in 151 （72. 9% ） patients by coronary angiography. Of the 93 patients with AAA suitable for EVAR coexisting with severe CAD, 6 （ 6. 5 % ） patients received one-stage EVAR ＋ PCI, 60 （ 64. 5 % ） patientsreceived EVAR followed by PCI and 27 （29. 0% ）patients received PCI followed by EVAR. There were no sig- nificant differences statistically with regard to age, gender, risk factors for arteriosclerosis, coronary profile and maximum diameter of AAA among the three groups. There was no in-hospital death in the one-stage EVAR ＋ PCI group, 1 （ 1.7% ） in the EVAR followed by PCI group and 2（7.4% ） in the PCI followed by EVAR group, without significant differences statistically with regard to in-hospital mortality. Complications were observed in 1 （ 16. 7% ） patient in the one-stage EVAR ＋ PCI group, 10（ 16.7% ） in the EVAR followed by PCI group and 3 （ 11.1% ） in the PCI followed by E

关 键 词：腹主动脉瘤 冠心病 手术策略 不良事件 

分 类 号：R54[医药卫生—心血管疾病]