血栓弹力图对经皮冠状动脉介入治疗术后并发症的影响及预测价值

Predictive effect and the influence of thromboelastography on prognosis of patients undergoing percutaneous coronary intervention

目的探讨血栓弹力图对经皮冠状动脉介入治疗术后并发症的影响及预测价值。方法取2015年8月至2016年9月该院收治的经皮冠状动脉介入治疗患者115例,根据最大血块强度(MA-ADP)水平分为MA-ADP<50mm组(n=101)和MAADP≥50mm组(n=14)。入院后完善相关检查,根据检查结果,采用血栓弹力图对治疗效果进行评估及指导。结果单因素分析显示,MA-ADP<50mm组与MA-ADP≥50mm组术后不良反应事件发生率与糖尿病、血脂异常及心肌梗死溶栓治疗危险评分(TIMI)分级差异无统计学意义(P>0.05);MA-ADP<50mm组术后高血压、回旋支梗死数及血小板水平均高于MA-ADP≥50mm组(P<0.05);多因素分析显示,MA-ADP<50mm组与MA-ADP≥50mm组术后不良反应事件发生率与高血压、回旋支梗死及血小板水平关系密切(P<0.05);两组治疗前血栓弹力图中R值、K值、α角及MA值差异无统计学意义(P>0.05);MAADP<50mm组治疗后R值、K值高于MA-ADP≥50mm组(P<0.05);MA-ADP<50mm组治疗后MA值低于MA-ADP≥50mm组(P<0.05);MA-ADP<50mm组治疗1年后心血管事件、支架再梗死及支架再狭窄发生率高于MA-ADP≥50mm组,差异有统计学意义(P<0.05)。结论经皮冠状动脉介入治疗患者采用血栓弹力图评估治疗效果较为理想,能指导及预测并发症发生情况,使得患者治疗更具针对性,值得推广应用。

Objective To investigate the predictive value and influencing factors of thrombelastography（TEG）on the prognosis of patients undergoing percutaneous coronary intervention（PCI）.Methods One hundred and fifteen patients who were treated with PCI from August 2015 to September 2016 were selected.According to the maximum blood clot strength（MA-ADP）,the patients were divided into MA-ADP50 mm group（n=101）and MA-ADP≥50 mm（n=14）.Patients were accepted the relevant inspection after admission,according to the results of the examination,TEG was used to evaluate the treatment and guidance.Results Univariate analysis showed that the incidence of adverse events had no correlation with diabetes mellitus,dyslipidemia and TIMI grade of the two groups（P〈0.05）.The rates of hypertension,numbers of circumflex artery infarction and level of platelet of the group of MA-ADP〈50 mm were significantly higher than that of the group of MA-ADP〈50 mm.The multivariate analysis showed that the incidences of adverse events were related with hypertension,numbers of circumflex artery infarction and level of platelet（P〈0.05）.Before treatment,patients in the group of MA-ADP〈50 mm had no significant difference with group of MA-ADP≥50 mm in R value,K value andαangle.After the treatment,R value,K value andαangle of the group of MA-ADP〈50 mm were significantly higher than that of the group of MA-ADP≥50 mm（P〈0.05）,and MA value in the group of MA-ADP50 mm was significantly lower than that of the group of MA-ADP≥50 mm（P〈0.05）.The incidences of cardiovascular events,stent restenosis and stent restenosis after one year of treatment in group MA-ADP50 mm group were significantly higher than MA-ADP ≥50 mm group（P〈0.05）.Conclusion TEG is an ideal method for percutaneous coronary intervention.It could guide and predict the incidence of complications,which makes the treatment more targeted and worthy of popularization and application.