冠心病患者PCI手术围术期发生心肌损伤的相关因素分析

摘要

Objective To explore the related factors of myocardial injury in perioperative period of percu-taneous coronary intervention (PCI) in patients with coronary heart disease. Methods A total of 288 patients with coronary heart disease scheduled for PCI were collected from February 2011 to January 2014, including 50 patients of stable angina (stable angina group) and 238 patients of unstable angina (unstable angina group). By monitoring the patients' high-sensitivity troponin levels before and after operation, the patients' myocardial injury situation in perioperative period of PCI was investigated. Logistic regression was used to analyze the risk factors of myocardial injury in perioperative period of PCI in patients with coronary heart disease. Results The myocardial injury rate were 62.04%in stable angina group and 68.91%in unstable angina group, with no statistically significant difference between the two groups (P>0.05). Logistic regression analysis showed that applying load rosuvastatin for preopera-tive treatment, the time of statin therapy before operation, the length of stents and the levels of apolipoprotein A were the independent risk factors for myocardial injury in perioperative period of PCI in patients with coronary heart disease. Conclusion Preoperative prolonged application of load rosuvastatin and apolipoprotein A can reduce myo-cardial injury in perioperative period of PCI in patients with coronary heart disease. The length of stents can increase the incidence of myocardial injury.%目的：探讨冠心病患者经皮冠脉介入治疗(PCI)手术围术期发生心肌损伤的相关因素。方法收集2011年2月至2014年1月来我院就诊并接受择期行PCI的冠心病患者288例，其中稳定型心绞痛组50例，不稳定型心绞痛组238例。术前及术后通过监测患者的高敏感肌钙蛋白水平，观察两组患者PCI手术围术期发生心肌损伤的情况，应用Logistic回归来分析冠心病患者行PCI手术围术期发生心肌损伤的的危险因素。结果稳定型心绞痛组与不稳定型心绞痛组患者PCI术后围手术期心肌损伤率分别为62.04%与68.91%，差异无统计学意义(P>0.05)。Logistic回归分析发现应用负荷量瑞舒伐他汀进行术前治疗、术前他汀治疗的时间、应用支架的长度及载脂蛋白A的水平均是围手术期冠心病患者PCI发生心肌损伤的独立危险因素。结论术前负荷量及长时间应用瑞舒伐他汀治疗、载脂蛋白A的水平可以降低冠心病患者行PCI手术围术期的心肌损伤；应用支架的长度能增加冠心病患者行PCI手术围术期的心肌损伤。