【作者】 杨培灵；

【导师】 张金盈；

【作者基本信息】 郑州大学 ， 心血管内科， 2010， 硕士

【摘要】 目的评价冠状动脉完全血运重建及不完全性血运重建介入和药物治疗对冠状动脉多支病变(Multivessel coronary disease MCD)患者的治疗效果,分析MCD患者预后的独立影响因素,为减少MACCE事件发生,获得更好的临床疗效提供证据。方法2008年6月至2009年9月在我院心内科住院,160位冠状动脉造影示多支冠脉病变患者且随访成功者,根据患者意愿和冠脉病变分为冠状动脉介入完全性血运重建组(治疗组A,n=66)、冠状动脉介入不完全性血运重建组(治疗组B,n=47)和内科常规药物治疗组(以下简称药物组,n=47),比较三组患者临床资料,随访6个月,观察终点为死亡发生和MACCE发生,观察三组患者在治疗6个月期间MACCE事件发生情况,6个月后心脏彩超射血分数。采用多因素logistic回归模型对左室EF的变化进行多因素分析。结果三组患者的性别构成、高血压、高脂血症、糖尿病、吸烟史及其入院时冠脉狭窄支数、心脏彩超射血分数差异无显著性意义；6个月后冠状动脉介入完全性血运重建组、冠状动脉介入不完全性血运重建组LVEF的增加优于药物组,冠状动脉介入完全性血运重建组、冠状动脉介入不完全性血运重建组之间LVEF变化无显著性意义；三组间MACCE发生率有显著性差异,两两比较示：只有完全性血运重建组与药物保守治疗组有显著性差异(13.6% vs 38.3% P=0.003),不完全性血运重建组与药物治疗组之间差异无显著性(P=0.073),完全性血运重建组及不完全性血运重建组间差异无显著性(P=0.287)。多因素Logistic回归分析示：男性、高血压、高血脂、吸烟史均与LVEF的改善负相关。结论(1)本研究提示冠状动脉介入完全性血运重建治疗对冠状动脉多支病变,可以显著地改善患者的心功能,降低MACCE的发生；冠状动脉介入不完全性血运重建和完全血运重建治疗均可以显著地改善患者的近期心功能。(2)本研究提示男性、高血压、高血脂、吸烟史均是MCD患者心功能改善不佳的影响因素。更多还原

【Abstract】 Objiective:This research is to retrospectively investigate the therapeutic effect of complete or incomplete revascularization or drug therapy in patients with multivessel coronary artery disease (MVD), As well as to identify the independent predictive factors of MCD patients in developing MACCE affecting the outcome. M ETHODS:From June 2008 to September 2009,160 patients with MVD treated in the inpatient department of cardiology were reviewed.According to treatment methods,160 patients were classified into complete revascularization group (n= 60),incomplete revascularization group (n=47) and the conservative group (n=47). The general conditions of the patients in three groups were collected and compared. Ejection factor (EF) of left ventricle were observed.The Primary end-Point was the happening of all cause death, the combined end-point was MACCE, including all cause death, recurrent infarction and the target vessel revascularization.Multivarite analysis was carried out using the Multiple logistic proportional hazards model to determine the variable relevant to the EF of left ventricle(LVEF). Results:There were no differences in sex,age, hypertension, hyperlipidemia, diabetes mellitus,smokers, NYHA, collareral circulations,the number of coronary stents and LVEF among three groups (P>0.05). After 6 months,the improvement of LVEF was remarkable higher in complete revascularization group and in incomplete revascularization group than in the conservative group(P= 0.000,P=0.000).There was not remarkable difference in the improvement of LVEF between complete revascularization group and incomplete revascularization group.The ratio of MACCE was found to be signifieantly different among three groups(P=0.009).The ratio of MACCE was remarkable higher in conversation group than in complete revascularization group (P=0.003), The ratio of MACCE was not remarkable different in incomplete revascularization group than in conversation group (P= 0.073).There was no remarkable diffenece between in complete revascularization group and in incomplete revascularization group(P=0.287). Multiple linear regression showed that hypertension,hyperlipidemia,man and smoke history were the negative dependend factors of LVEF.Conclusions:(1) complete revascularization treatment and incomplete revascularization treatment could remarkabley improve the patients’ LVEF.And in complete revascularization treatment could decrease the MACCE ration than in incomplete revascularization treatment and in conversation treatment in treating MVD patients.(2) hypertension,hyperlipidemia,man and smoke history were the worsen factor of MVD patients.更多还原