冠心病患者PCI围术期心肌损伤的影响因素  

Influencing factors of perioperative myocardial injury in coronary heart disease patients with PCI

作　　者：任进平 

机构地区：[1]北京怀柔医院,北京101400

出　　处：《实用临床医药杂志》2017年第11期5-7,11,共4页Journal of Clinical Medicine in Practice

基　　金：北京市科技局基金项目(20150425)

摘　　要：目的探讨行经皮冠脉介入治疗(PCI)术的冠心病患者围术期出现心肌受损现象的影响因素。方法分析接受择期经皮冠脉介入治疗(PCI)治疗的87例冠心病患者的临床资料,其中稳定型心绞痛(SAP)患者23例,不稳定型心绞痛(UAP)患者64例。比较2组患者的一般临床资料、PCI术相关资料、PCI围术期出现心肌受损和心肌梗死的情况,采用多因素Logistic回归分析PCI围术期出现心肌受损的影响因素。比较入院时术前使用他汀>1月与≤1月患者的血脂水平。结果 2组患者的一般临床资料无显著差异(P>0.05)。SAP组的支架植入处的分叉病例比例显著高于UAP组(P<0.05)。2组患者PCI围术期出现心肌受损、心肌梗死的概率及术后的hs-CRP水平均无显著差异(P>0.05)。PCI围术期患者心肌受损的发生与载脂蛋白A、术前使用他汀1月以上、术前他汀负荷剂量治疗以及植入支架的总长度相关(P<0.05)。入院时术前使用他汀>1月患者的TC与LDL水平明显低于≤1月患者(P<0.05)。结论载脂蛋白A的表达水平、PCI手术前采用负荷剂量的瑞舒伐他汀进行治疗以及术前应用他汀治疗1个月以上与PCI术围术期的心肌受损发生率的降低相关,冠脉内支架植入的总长度则与心肌受损发生率的上升相关。Objective To explore the influencing factors of perioperative myocardial injury in coronary heart disease patients with PCI. Methods Clinical materials of 87 coronary heart disease pa- tients with PCI were retrospectively analyzed, including 23 stable angina pectoris patients （SAP） and 64 unstable angina pectoris patients （SAP）. The general information, PCI operation related data, the perioperative myocardial injury and myocardial infarction were compared between two groups. The in- fluencing factors of perioperative myocardial injury in coronary heart disease patients with PCI were an- alyzed by Logistic regression. The level of blood fat was compared between patients with administration of rosuvastatin 〉 1 month and ≤ 1 month. Results There was no significant difference of general in- formation between two groups （P 〉 0.05）. In the SAP group, the number of SAP patients with stent implantation was significantly higher than that of UAP group （ P 〈 0.05 ）. There was no significant difference between the two groups in myocardial injury, myocardial infarction, and the level of hs-CRP after PCI （P 〉 0.05）. The incidence of myocardial damage in patients with PCI during perioperative period was associated with apolipoprotein A, preoperative statin use, preoperative statin dose therapy, and total length of the stent （P 〈 0.05 ）. At the time of on admission and preoperative, TC and LDL levels of patients with use of statins over one month before operation on admission was significantly lower than patients with use of statins less than one month （P 〈 0.05 ）. Conclusion The loading of apo- lipoprotein A expression, use of rosuvastatin before PCI, use of statin over 1 month are closely related with the decrease of myocardial injury rate in perioperative period of PCI, and the total length of intra- coronary stent implantation is associated with increasing incidence of myocardial damage.

关 键 词：经皮冠脉介入治疗 瑞舒伐他汀 载脂蛋白A 围手术期心肌受损 冠心病 

分 类 号：R541.4[医药卫生—心血管疾病]