老年冠心病患者冠状动脉搭桥术后再发心绞痛介入治疗的近期效果

Recent results of percutaneous coronary intervention for recurrent angina in elderly patients with coronary disease after coronary artery bypass graft

目的：分析冠状动脉搭桥术后（CABG）的老年冠心病患者再发心绞痛,给予不同治疗方式（优化药物治疗、介入治疗）后心脏血流动力学及神经内分泌变化,以及评价CABG后再发心绞痛介入治疗的近期效果。方法：收集2007-01-2012-12在本院CABG后近期复发心绞痛患者的入院临床基线资料,根据是否行介入手术,分为两组：第1组在优化药物的基础上给予桥血管或者原位血管介入治疗（PCI组）,第2组给予优化药物治疗（ODT组）。3个月后随访心脏相关辅助检查结果、心功能、主要不良心血管事件（MACE）以及患者预后情况。结果：PCI组肾素、血管紧张素Ⅱ、醛固酮、去甲肾上腺素、肾上腺素、血红蛋白、肌酐、脑钠肽、左室舒张内径、左室射血分数方面均低于ODT组,差异有统计学意义（P〈0.05）。多因素Logistic回归分析,血红蛋白水平是胸痛症状的相关因素（B：-3.991,S.E：1.940,Wals：4.231,P=0.04,OR：0.018,95%CI：0.000~0.828）。采用Pearson相关分析了解心脏功能与神经内分泌水平的相关性,二者具有统计学意义（P〈0.05）。结论：PCI较ODT显著降低心脏相关的不良因子水平;PCI总有效率优于ODT组;血红蛋白水平与临床胸痛症状有关;心脏功能与神经内分泌水平有一定的相关性。

Objective：To analyze the changes of hemodynamics and neuroendocrine in elderly patients with optimal medical therapy or interventional therapy for recurrent angina after coronary artery bypass graft（CABG）.And to evaluate the recent effect of interventional treatment for recurrent angina after artery bypass surgery.Method：The patients with recurrent angina after CABG were collected from January 2007 to December 2012 in our Hospital.They were divided into two groups.The first group was treated with PCI and optimized drug treatment（PCI group）.The second group received optimize drugs treatment（ODT group）.Three months later,heart-related auxiliary findings,cardiac function,major adverse cardiovascular events（MACE）and prognosis were followed-up.Result：In PCI group,it showed significantly decrease in PRA,AngⅡ,ALD,NE,E,Hb,Cr,BNP,LV and EF（P〈0.05）,compared with ODT group.Level of Hb was related to chest pain symptoms（B：-3.991,S.E：1.940,Wals：4.231,P=0.04,OR：0.018,95% CI：0.000-0.828）.Conclusion：Associated cardiac adverse factors reduce in PCI group,compared with ODT group.