冠心病患者PCI围手术期不同类别操作血管的特点及血清cTnI升高的相关因素  

Characteristics of surgery of different blood vessels in patients with coronary heart disease during perioperative period of PCI and related factors of elevated serum cTnI

作　　者：邱珺[1] 吴刚 张冰 QIU Jun WU Gang ZHANG Bing(Graduate College, Inner Mongolia Medical University, Inner Mongolia Autonomous Region, Hohhot 010110, Inner Mongolia, China Department of Cardiology, Hulunbuir People＇s Hospital, Inner Mongolia Autonomous Region, Hailaer 021008, Inner Mongolia, China)

机构地区：[1]内蒙古医科大学研究生学院,内蒙古呼和浩特010110 [2]呼伦贝尔市人民医院心内科,内蒙古海拉尔021008

出　　处：《心脏杂志》2017年第1期78-82,共5页Chinese Heart Journal

摘　　要：目的观察和分析冠心病患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗围手术期不同类别操作血管的特点及心肌肌钙蛋白I(cardiac troponin I,cTnI)升高的相关因素。方法收集2014年3月~2015年11月,择期行PCI术的156例冠心病患者,根据操作血管分为前降支组(74例)、回旋支组(29例)和右冠脉组(53例),均为单支血管操作。根据术后cTnI变化情况将前降支组分为cTnI升高组(44例)和cTnI无变化组(30例)。所有患者均检测术前及术后3 h的cTnI,记录患者的各项基本资料、手术操作及术前血脂、血糖、肾功、离子等生化指标。结果前降支组术后cTnI较术前显著升高(P<0.01),回旋支组及右冠脉组术后cTnI较术前无显著变化。3组间支架:总长度、平均直径、总释放压力、总释放时间;球囊:扩张次数、总释放压力、总释放时间、单次扩张最大压力、是否后扩张;手术时间差异有统计学意义(P<0.05)。cTnI升高组术前低密度脂蛋白胆固醇(LDL-C)、C反应蛋白(CRP)高水平所占百分比及球囊单次扩张最长时间明显高于无变化组(P<0.05)。结论 1前降支病变患者PCI术后早期血清cTnI水平较术前明显升高;2术前LDL-C高水平、CRP高水平、球囊单次扩张最长时间可能为PCI术后早期cTnI升高的危险因素。AIM To observe and analyze the correlation between postoperative cardiac troponin I levels and the effect of selective percutaneous coronary intervention （PCI） on patients with coronary heart disease. METHODS One hundred and fifty-six patients undergoing elective PC1 were enrolled between March 2014 and November 2015. Patients were divided into three groups according to coronary anatomy and lesion： LAD group （ n = 74 ）, LCX group （ n group were subdivided into two groups according = 29 ） and RCA group （ n = 53 ）. Patients in LAD to the levels of cTnI after operation： elevated group （ n = 44） and non-change group （n = 30）. Levels of cTnI were determined in all patients 3 h before and after PCI. Patients＂ basic data, surgical indicators and preoperative renal function, blood sugar, blood lipids, plasma and other biochemical markers were also recorded. RESULTS Postoperative cTnI levels increased significantly compared with those preoperative （ P 〈 0.01 ） in LAD group. No significant changes were found in LCX and RCA groups. Significant differences were found in the total length, mean diameter, total release pressure and total release time of stents, times of expansion, total release pres- sure, total release time, single expansion maximum pressure and whether to perform post-expansion of balloon, and in surgical time among the three groups. Proportion of preoperative high levels of LDL-C and CRP and single expansion maximum time of balloon in elevated group were significantly higher than those in the non-change group. CONCLUSION Postoperative cTnI increases significantly compared with the preoperative value （P 〈 0. 05） in patients with LAD lesions. The preoperative high level of LDL-C, high level of CRP and single expansion maximum time of balloon may be predictors of the increase of cTnI after PCI.

关 键 词：经皮冠状动脉介入治疗 围手术期心肌梗死 心肌肌钙蛋白I 

分 类 号：R541.4[医药卫生—心血管疾病]