药物洗脱支架介入治疗冠心病三支病变合并糖尿病患者的临床观察

Clinical follow-up study of implanting drug-eluting stents in the triple-vessel disease patients with diabetes mellitus

目的:观察冠心病三支病变合并糖尿病患者置入药物洗脱支架的安全性及近、中期疗效。方法:2003年10月～2007年10月间57例经冠状动脉造影证实为冠心病三支病变合并糖尿病的患者置入药物洗脱支架。男38例、女19例,年龄41～79岁,平均62岁,其中稳定型心绞痛17例,不稳定型心绞痛40例。糖尿病史2～12年,其中胰岛素治疗26例,采用常规经皮冠脉介入治疗。结果:全部患者支架置入成功,临床症状明显好转或消失,57例患者共治疗193处病变,置入药物洗脱支架277枚。1例(1.8%)患者术后d4支架内亚急性血栓形成。41例(71.9%)患者术后6个月行冠脉造影,3例(7.3%)患者支架内再狭窄,选择外科搭桥治疗。随访12个月,无死亡、心肌梗死等严重心脏事件发生。结论:药物洗脱支架治疗冠心病三支病变合并糖尿病患者安全有效,近、中期效果好,远期疗效有待证实。

Objective：To observe the safety and short-and mid-term effects of implanting dmg-eluting stents in the triple-vessel disease patients with diabetes mellitus.Methods：From Oct.2003 to Oct.2007,a total of 57 triple-vessel disease patients with diabetes mellitus who were proven by coronary angiography,including 17 SAP and 40 UAP,were treated with drug-eluting stents.There were 38 males and 19 females,whose ages was from 41 to 79 years （average age 62±16 years）.Diabetic history was from 2 to 12 years,and 26 patients used insulin.They received routine percutaneous coronary intervention（PCI）.These patients were required to do coronary angiography （CAG） sixmonths later.Results：All patients were implanted drug-eluting stems successfully, and their clinical symptom were markedly alleviated or disappeared.Total 193 lesions were treated with 277 drug-eluting stents in 57 patients.Sub-acute in-stent thrombosis happened in one case on fourth day after operation.Forty one patients received CAG six months later,with 71.9% of CAG follow-up rate,and 3 （7.3%） of 41 patients had in-stent restenosis（ISR）,who selected CABG.At twelve months follow-up after operation,there were no serious cardiovascular events such as death and recurrent myocardial infarction.Conclusion：The implantation of drug-eluting stents is safety and efficacy in triple-vessel disease patients with diabetes mellitus, and short-and mid-term effect is inspiring,but long-term result should be validated.