摘要
目的对比研究冠状动脉旁路移植术（CABG）和经皮冠状动脉介入术（PCI）治疗复杂冠状动脉病变合并左心功能不全（LVD）的围术期疗效。方法回顾性分析2003年1月~2013年12月在我院接受CABG和PCI治疗的复杂冠脉病变合并左心功能不全（左室射血分数LVEF≤50%）患者的临床资料,其中CABG患者386例,PCI患者580例,采用1∶1配对方法,以EuroSCORE危险因素及术前超声心动图指标为配对标准,两组各纳入患者135例,比较两组患者近期结果及术前术后左室形态及功能变化。结果两组患者基线资料比较,PCI组慢性肺病及3个月内心梗发生率显著高于CABG组（8.1%vs 0.7%,P=0.003;64.4%vs 31.9%,P=0.000）,而左主干病变比例显著低于CABG组（12.6%vs 23.7%,P=0.018）,其它方面两组之间无统计学差异。血运重建结果比较：CABG组处理的靶血管数目明显多于PCI组（2.90±0.81 vs 1.67±0.73,P=0.000）,完全再血管化程度明显高于PCI组（94.8%vs 51.8%,P=0.000）。术后术前超声结果比较：CABG组与PCI组LVEF差值无显著差异（P=0.171）,而CABG组LVEDD差值明显高于PCI组（P=0.000）。围术期不良事件方面,两组住院死亡率及其它严重并发症无统计学差异。结论对于复杂冠脉病变合并LVD患者,CABG与PCI均为安全可行的血运重建方式。与PCI相比,CABG完全再血管化程度更高,术后早期左心功能改善更为明显。
Objective To compare the perioperative outcomes of coronary artery bypass grafting（CABG） and percutaneous coronary intervention（PCI） for treatment of complex coronary artery disease and left ventricular dysfunction. Methods The clinical data of 966 patients admitted to our hospital from January 2003 to December 2013 with coronary artery disease and left ventricular dysfunction（ejection fraction ≤50%） were retrospectively reviewed. Among the patients, 386 underwent CABG and 580 received PCI. After matching for Euro SCORE risk factors and preoperative echocardiographic parameters, 135 patients with CABG and 135 with PCI were enrolled in this study. With hospital mortality and perioperative major complications as the endpoints, the early outcomes of the procedures were evaluated. Perioperative echocardiography was performed to evaluate the change of left ventricular geometry and function. Results Compared with CABG group, PCI group had significantly higher incidences of chronic lung disease（8.1% vs 0.7%, P=0.003） and recent myocardial infarction（64.4% vs31.9%, P=0.000） but significantly lower left- main disease（12.6% vs 23.7%, P=0.018）; the other baseline characteristics were comparable between the two groups. Patients with CABG had a greater number of treated target vessels than those with PCI（2.90±0.81 vs 1.67±0.73, P=0.000）, and complete revascularization was more common in CABG group（94.8% vs 51.8%, P=0.000）.No significant difference was found in perioperative variations of LVEF between the two groups, but patients with CABG had a greater variation in LVEDD than those with PCI. The hospital mortality and other major complications were similar between the two groups. Conclusion Both CABG and PCI are safe and reliable revascularization strategies for complex coronary artery disease and left ventricular dysfunction, but CABG can achieve a higher rate of complete revascularization and better improves the left ventricular function.
出处
《南方医科大学学报》
CAS
CSCD
北大核心
2016年第3期327-331,共5页
Journal of Southern Medical University
关键词
血运重建
冠状动脉旁路移植术
经皮冠状动脉介入术
左心功能不全
myocardial revascularization
coronary artery bypass grafting
percutaneous coronary intervention
left ventricular dysfunction
作者简介
申磊磊，医师，在读硕士研究生，E—mail：justshenleilei@163．com
通信作者：王嵘，副主任医师，硕士，电话：010-66937572，E-mail：wangrongd@126．com
