冠状动脉粥样硬化性心脏病患者经皮冠状动脉介入治疗围手术期出血的相关影响因素及生存状况研究

摘要

目的 探究围手术期出血对冠状动脉粥样硬化性心脏病(冠心病)患者经皮冠状动脉介入治疗术(PCI)后生存状况的影响.方法 回顾性分析2013年1月-2015年1月于该院收治的10672例冠心病患者的临床资料,所有患者均采用PCI治疗.根据围手术期是否发生出血将患者分为出血组(n=1479)和无出血组(n=9193).分析两组患者的临床资料,住院期间、随访1、6和12个月的终点事件,采用Cox比例风险回归分析围手术期出血与术后12个月终点事件的关系.结果 出血组患者的平均年龄、ST段抬高型心肌梗死比例高于无出血组患者,出血组患者的不稳定性心绞痛比例、肌酐清除率均低于无出血组患者,出血组患者出院带药较无出血组阿司匹林比例低,西洛他唑比例高,出血组患者经然动脉途径介入治疗、使用主动脉内球囊反搏和血管内超声的比例高于无出血组患者,差异有统计学意义(P<0.05).随访6和12个月出血组患者的总主要心脑血管不良事件发生率高于无出血组患者,且出血组患者的心源性死亡率高于无出血组,差异有统计学意义(P<0.05).将无出血组作为对照,出血学术研究会≥2级出血是冠心病患者术后12个月终点事件的危险因素(P<0.05).结论 PCI围术期出血是冠心病患者术后12个月终点事件的危险因素,临床中应采取有效措施减少PCI围术期出血,以期改善冠心病患者术后生存率.%Objective To explore the perioperative bleeding and the living condition of patients with coronary heart diseases (CHD) having percutaneous coronary intervention (PCI). Methods The clinical data of 10,672 patients with coronary heart diseases admitted to our hospital between January 2013 and January 2015 were retrospectively analyzed. All patients were treated with PCI. According to whether perioperative hemorrhage occurred the patients were divided into bleeding group ( n=1,479) and non-bleeding group ( n=9,193). The clinical data, endpoint events during hospitalization and follow-up of 1 month, 6 months and 1 year were compared between the two groups, Cox proportional hazards regression analysis was used to analyze the relationship between perioperative bleeding and end point events. Results The average age was older and the rate of myocardial infarction with ST segment elevation was higher in the patients with hemorrhage than in the patients without bleeding. The proportion of unstable angina and creatinine clearance in the patients with bleedin g were lower than those in the patients without bleeding. The proportion of the patients taking Aspirin after discharge from hospital was lowe,r while that of the patients taking Cilostazol was higher in the bleeding group than in the non-bleeding group. The proportions of the patients receiving natural artery interventional therapy, IABP and intravascular ultrasound were significantly higher in the bleeding group than in the non-bleeding group ( P< 0.05). In the 6th and 12th month of follow-up, the total incidences of major adverse cardiovascular events and cardiac mortality in the hemorrhage group were significantly higher than those in the non-bleeding group ( P<0.05). Taking non-bleeding group as control, bleeding of BARC ≥grade 2 was the risk factor of end-point events in the patients with coronary heart disease ( P< 0.05). Conclusions Perioperative bleeding is the risk factor of end-point events after PCI in patients with coronary heart diseases after 1-year follow-up. Effective measures should be taken in clinic to reduce PCI perioperative bleeding so as to improve survival rate of patients with coronary heart diseases.