“分站式”杂交血运重建技术对多支冠状动脉病变患者cTnT、血流动力学和预后的影响

Effect of “Split Station” hybrid revascularization on cTnT, hemodynamics and prognosis in patients with multiple coronary artery diseases

目的探讨应用"分站式"杂交血运重建技术(HCR)治疗多支冠状动脉病变(MVD)及对心肌肌钙蛋白T(cTnT)、血流动力学和预后的影响。方法选取冠状动脉多支病变患者110例,按照手术方式的不同分成对照组和观察组,每组55例。对照组患者行单纯冠状动脉介入治疗(PCI),观察组患者行HCR治疗。术后分别对两组患者的血清心肌损伤标志物水平、血流动力学指标水平进行比较,并对两组患者进行为期两年的院后随访,比较两组患者随访期间的不良心脑血管事件发生率以及血管通畅率。结果①术后两组患者的血清丙二醛(MDA)、肌酸激酶同工酶(CK-MB)和肌钙蛋白(cTnT)水平均较术前显著升高(P<0.05),且观察组患者的血清MDA、CK-MB和cTnT水平明显高于对照组(P<0.05);②术后两组患者的心输出量(CO)、左室舒张早期血流传播速度(FPV)、每搏输出量(SV)水平均较术前升高(P<0.05);且观察组患者的CO、FPV、SV水平显著高于对照组(P<0.05);③随访期间观察组患者的不良心脑血管事件发生率(3.64%)显著低于对照组(P<0.05);④观察组患者的血管通畅率(94.55%)显著高于对照组(72.22%)(P<0.05)。结论应用HCR对MVD患者进行治疗,能够有效改善患者的心肌损伤情况以及血流动力学情况,减少不良心脑血管事件的发生,具有较好的近中期预后,值得临床上广泛推广。

Objective To explore the application of staged hybrid coronary artery revascularization in the treatment of multivessel coronary artery disease(MVD) and its influence on cardiac troponin T(cTnT), hemodynamics and prognosis. Methods 110 patients with multivessel disease were selected and divided into control group and observation group according to different surgical methods, 55 cases in each group. Patients in the control group were treated with percutaneous transluminal coronary intervention, while patients in the observation group were treated with staged hybrid coronary artery revascularization. After operation, the levels of serum myocardial injury markers and hemodynamic indexes were compared between the two groups, and followed up two groups for two years. Comparing the incidence of adverse blood and cerebrovascular events and the patency rate of blood vessels between two groups. Results ① The serum levels of MDA,CK-MB and cTnT in the two groups were higher than those before treatment(P<0.05), and the serum levels of MDA, CK-MB and cTnT in the observation group were higher than those in the control group(P<0.05).② CO,FPV and SV were significantly higher in the two groups than in the preoperative group(P<0.05), and the levels of CO, FPV and SV in the observation group were significantly higher than those in the control group(P<0.05).③ The incidence of adverse cardiovascular and cerebrovascular events in the observation group during the follow-up period(3.64%) was significantly lower than that in the control group(P<0.05). The vascular patency rate of the observation group(94.55%) was significantly higher than that of the control group(72.22%, P<0.05). Conclusion The application of staged hybrid coronary artery revascularization in the treatment of multivessel coronary artery disease can effectively improve the degree of myocardial injury and hemodynamics, and reduce the incidence of adverse cardiovascular and cerebrovascular events. It has a good prognosis in the near and medium term, which is worth popularizing widely in clinic.