非ST段抬高性急性冠状动脉综合征的治疗策略

Treatment Strategy of Non-ST-Segment Elevation Acute Coronary Syndrome

目的研究药物治疗与介入治疗对非ST段抬高性急性冠状动脉综合征患者生存时间的影响。方法在辽宁省10城市选择14家医院,连续入选入院时非ST段抬高性急性冠状动脉综合征患者。填写调查表,并于出院后30d、90d和180d随访,获得完整资料900份。观察患者的基线特征、药物治疗及介入治疗干预情况和终点事件。结果入选的900例中介入治疗患者226例,年龄61.1±10.7岁;药物治疗患者674例,年龄65.9±10.8岁。介入治疗组既往心功能衰竭史、中风史及吸烟史少于药物治疗组(P<0.05),介入治疗组住院期间出现反复心绞痛、心功能衰竭的比例以及出院后90d和180d死亡、非致命性心肌梗死和心功能衰竭等事件明显少于药物治疗组(P<0.05),介入治疗组住院期间和出院180d应用阿斯匹林、氯吡格雷、低分子肝素、他汀类及钙离子拮抗剂高于药物治疗组,但应用抗心律失常药物低于药物治疗组(P<0.05),药物治疗组与介入治疗组相比生存率明显下降,但两组曲线生存率差异无显著性。结论非ST段抬高性急性冠状动脉综合征患者介入治疗明显降低住院期间及出院后180d心肌缺血事件。

Aim To study the effect of survival time of the patients who had non-ST-segment elevation acute coronary syndrome with different treatments. Methods Patients suffered successively from non-ST-segment elevation acute coronary syndrome were chosen initially in 14 flfird-class or second-class hospitals in 10 cities of Liaoning, with questionaire filled in and follow-up when the patients discharged from hospital after 30 days, 90 days, and 180 days, to get 900 complete data. All patients were divided into interventional therapy group and drug treatment group. Observational target included the patients＇ characters of base line, clinical interference measure and end paint events. Results Mean age of patient was 61.1 ± 10.7 years in the interventional therapy group and 65.9 ±10.8 years in the drug treatment group, history of congestive cardiac failure and smoking in the past and incidence of cerebral accident in the interventional therapy group were fewer than those in the drug treatment group （ P 〈 0.05 ）. The incidence rate of reangina pectofis attacks, congestive cardiac failure, rate of death in follow-up 90 and 180 days, nonfatal myocardial infarct, congestive cardiac failure in the interventional therapy group was fewer than that in the drug treatment group（ P 〈 0.05）. Using drug in follow-up 90 and 180 days, the rate of using drug, such as aspirin, clopidogrel, low molecular heparin, stain, calcium antagonist in the interventional therapy group was higher than that in the drug treatment group. Survival rate in, interventional therapy group was higher than that of the drug treatment group, but there was no significant difference between the interventional therapy group and drug treatment group （ P 〉0. 05 ）. Conclusion Interventional therapy can reduce incidence rate of myecardial infarct in period of hospital and follow-up 180 days.