摘要
目的分析经皮冠状动脉介入治疗(PCI)的发展及现状,为进一步提高PCI水平提供借鉴。方法回顾性分析1989年8月至2007年4月沈阳军区总医院心内科10225例PCI的冠心病住院患者的17762处靶病变临床和造影基线分布特征、PCI策略及围术期结果。结果患者年龄22～92岁,平均59.9岁。合并糖尿病2057例(20.1%),急性冠状动脉综合征8647例(84.6%),急性心肌梗死(AMI)急诊PCI1428例(14.0%),心源性休克477例(4.7%),多支病变6701例(65.5%),左主干病变483例(4.7%),慢性完全闭塞病变(CTO)1795例(17.2%)。总的病例成功率为98.5%,病变成功率98.3%,其中左主干病变成功率99.6%,CTO病变成功率90.5%。支架置入占总病例数的89.8%,人均置入支架1.45枚。AMI急诊PCI患者住院病死率4.4%(63/1428),AMI合并心源性休克患者住院期病死率19.7%(42/213)。围术期总病死率1.1%(113/10225),其中术中心源性死亡2例(0.02%),术后心源性死亡80例(0.8%)。围术期急诊冠状动脉搭桥2例(0.02%),急性、亚急性支架内血栓58例(0.57%),术中慢血流或无复流127例(占AMI急诊PCI总数的8.9%),总的围术期重要并发症发生率3.6%,其中与PCI操作相关的并发症发生率0.48%。存活出院者心绞痛缓解率98.6%。结论在技术成熟的心内科,PCI适应证范围广、成功率高、并发症发生率低、近期疗效较好,可作为冠心病的首选治疗手段之一,尤其对于AMI、心源性休克、左主干病变等高危患者,PCI可显著改善患者的近期预后。
Objective To analyze the trends and status of perculaneous coronary intervention（PCI） in Shenyang General Hospital of P. L. A. during a 18-year period. Methods Between August 1989 and April 2007,a total of 10 225 patients with 17762 target lesions had undergoue PCI. Their clinical and angiographie baseline characteristics, PCI strategies and perioperative outcomes were retrospectively analyzed. All data were collected from PCI database of our hospital. Results Patients＇ age ranged from 22 to 92 years old （ mean,59.9 years）. A total of 2057 patients （20. 2% ） were with diabete, 8647 （84. 6% ） with acute coronary syndromes, 1428 （ 14.0% ） with acute myocardial infarction （AMI） and underwent emergent PCl,477 （4. 7 % ）with cardiogcnic shock ;6701 （65.5 % ）with muhivessel disease,483 （4. 7 % ）with left main disease and 1795 （ 17.2% ）with chronic total occlusions （CTO）. Overall patient success rate was 98.5% and lesion success rate was 98. 3%. Procedural success was obtained in 99. 6% of patients with left main disease and 90. 5% of CTO lesions. About 89.8% of all patients underwent coronary stenting. Mean implanted stent number was 1.45 per patient. Inhospital mortality was 4.4% （ 63/1428 ） for AMI patients who underwent emergent PCI and 19. 7% （42/213） for AMI patients with cardiogenie shock. Overall perioperative mortality was 1.1% （ 113/10 225 ） , including 2 deaths during procedure （ 0. 02% ） and 80 （0. 8% ） deaths after proeedure. Two patients （ 0.02% ） underwent emergent CABG. Acute or subacute stent thrombosis occurred in 58 patients（0. 57% ）and slow flow or no-reflow occurred in 127 patients, which accounted for 8.9% of AMI patients who underwent emergent PCI. Overall incidence of perioperative complications was 3.6% and the rate of procedure related complications was 0. 48%. Conclusion In skilled cardiac center ,PCI is associated with high proceduralsuccess rate,low incidence of complications and good short-term outcomes. PCI should be the first choice for treating patients with coronary artery disease, especially for high risk patients with AMI, cardiogenic shock or left main disease, etc.
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2007年第23期1832-1835,共4页
Chinese Journal of Practical Internal Medicine
基金
全军临床高新技术重大基金([2002]卫医字第18号)
