| 田艳丰,张冬伟,曹其栋,田 平,梁兆光.药物洗脱支架植入术与冠状动脉旁路移植术治疗冠心病多支病变伴糖尿病患者的临床效果分析[J].,2017,17(28):5585-5589 |
| 药物洗脱支架植入术与冠状动脉旁路移植术治疗冠心病多支病变伴糖尿病患者的临床效果分析 |
| Analysis of the Clinical Effect of Drug-eluting Stent Implantation and Coronary Artery Bypass Grafting on the Patients with Multivessel Coronary Artery Disease Complicated with Diabetes Mellitus |
| 投稿时间：2017-05-23 修订日期：2017-06-15 |
| DOI：10.13241/j.cnki.pmb.2017.28.043 |
| 中文关键词: 药物洗脱支架 经皮冠状动脉介入治疗 冠状动脉旁路移植术 糖尿病 多支病变 |
| 英文关键词: Drug-eluting stents Percutaneous coronary intervention Coronary artery bypass grafting Diabetes Multivessel disease |
| 基金项目:黑龙江省科技攻关项目(GC05C40303) |
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| 中文摘要: |
| 摘要 目的：比较药物洗脱支架(DES)植入术及冠状动脉旁路移植术(CABG)治疗冠心病多支病变伴糖尿病患者的近期及远期临床疗效。方法：回顾性分析2014年1月～2016年10月在哈尔滨医科大学附属第一医院经冠状动脉造影证实为多支血管病变并伴有糖尿病的患者186例，根据血运重建方式的不同分为DES组及CABG组，随访50.5±14.3个月，观察两组患者住院期间及随访期主要不良心脑血管事件(包括非致死心肌梗死、脑卒中、再次血运重建、全因死亡)的发生情况。结果：在所有入选患者中，DES组有更多双支病变(P<0.05)，CABG组三支病变较多(P<0.05)，两组在完全血运重建方面无显著性差异(P>0.05)。住院期间，CABG组死亡2例(2.3%)，DES组死亡1例(1.0%)，死亡率比较无统计学意义(P>0.05)。两组均未出现非致死性心肌梗死、脑卒中、再次血运重建。出院后对186例入选患者随访，其中失访11例(DES组5例，CABG组6例)。随访期间CABG组发生非致死性心肌梗死1例(1.3%)、脑卒中6例(7.5%)、全因死亡10例(12.5%)，DES组发生非致死性心肌梗死5例(5.3%)、脑卒中3例(3.2%)、全因死亡9例(9.5%)，两组间比较差异无统计学意义(P>0.05)；而CABG组再次血运重建2例(2.5%)，DES组15例(15.8%)，两组比较差异具有统计学意义(P<0.01)。结论：行DES置入术或CABG术治疗冠心病多支病变伴糖尿病患者，住院期间主要心脑血管不良事件发生率、远期非致死性心肌梗死、脑卒中、全因死亡发生情况均无显著性差异，但DES组再次血运重建率明显升高，可能与糖尿病患者较高的再狭窄率有关。 |
| 英文摘要: |
| ABSTRACT Objective: To compare the short and long-term clinical efficacy of drug-eluting stent (DES) implantation and coronary artery bypass grafting (CABG) in the treatment of patients qith CHD multi-vessel disease and diabetes. Methods: 186 cases of patients with CHD multi-vessel disease and diabetes were selected in the First Affiliated Hospital of Harbin Medical University from January 2014to October 2016, 95 patients for DES treatment and 80 patients for CABG. All the patients were followed-up for 50±14 months, the incidence of clinical endpoint events (including non-fatal myocardial infarction, stroke, revascularization, and all-cause mortality) were compared between two groups. Results: Compared with the CABG group, the DES set had more patients with two lesions(P<0.05) and CABG group had more patients with three lesions (P<0.05). There was no significant difference in the complete revascularization between two groups(P>0.05). During hospitalization, there were 2 deaths in CABG group(2.3%), 1 death in DES group, no statistically significant difference was found between two groups (P>0.05). No non-fatal myocardial infarction, stroke, revascularization was found in both groups. After 50 ± 14 months' follow-up, in 175 cases of patients, there were 1 non-fatal myocardial infarction(1.3%)，6 strokes(7.5%), 10 deaths(12.5%) in the CABG group; and there were 5 non-fatal myocardial infarction(5.3%), 3 strokes(3.2%), 9 deaths (9.5%) in the DES group. There was no statistical difference(P>0.05). There were 2 cases of revascularizations in the CABG group(2.5%) and 15 cases of revascularizations in the DES group(15.8%) that was significantly higher than that of the CABG group(P<0.01). Conclusion: In thoese coronary multivessel disease associated with diabetes who underwent DES-PCI surgery or CABG surgery treatment, there was no significant difference in the incidence of cardiovascular and cerebrovascular adverse events during hospital, long-term clinical efficacy including non-fatal myocardial infarction, stroke and all-cause death. However, long-term revascularization increased significantly in the DES-treated patients with CHD multi-vessel disease and diabetes. |
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