冠心病患者择期PCI术中发生冠脉慢血流的危险因素分析

Analysis of risk factors of coronary slow flow during PCI in patients with coronary heart disease

目的:分析冠心病(CHD)患者择期经皮冠状动脉介入治疗(PCI)术中发生冠状动脉慢血流(CSF)的危险因素。方法:回顾性分析2017年1月至2018年12月在新疆医科大学第一附属医院行PCI治疗的239例CHD患者的临床资料,根据PCI术中是否发生CSF分为发生CSF组(CSF组,n=43)及未发生CSF组(N-CSF组,n=196)。记录两组左前降支(LAD)、左回旋支(LCX)、右冠状动脉(RCA)3支主要冠脉分支校正的心肌梗死溶栓试验(TIMI)帧数(CTFC)情况,采用Logistic回归分析法评估CHD患者择期PCI术中发生CSF的危险因素。结果:CSF组LAD、LCX、RCA的CTFC均高于N-CSF组(P<0.05)。CSF组高血压、糖尿病患病率及术前血红蛋白(Hb)、超敏C反应蛋白(hs-CRP)、肌钙蛋白Ⅰ(cTnⅠ)水平均高于N-CSF组(P<0.05)。高血压、糖尿病及术前高Hb、高hs-CRP、高cTnⅠ是影响择期PCI术中发生CSF的独立危险因素(OR=1.861、1.782、2.447、2.540、3.068,均P<0.05)。结论:高血压、糖尿病及术前高水平Hb、hs-CRP、cTnⅠ均能影响PCI术中CSF发生,临床应积极采取防控措施以改善CHD患者预后。

Objective:To evaluate the risk factors of coronary slow flow(CSF)occurrence during percutaneous coronary intervention(PCI)in patients with coronary heart disease(CHD).Methods:The clinical data of 239 patients with CHD who underwent PCI from January 2017 to December 2018 in our hospital were retrospectively analyzed.According to whether CSF occurred during PCI,CHD patients were divided into CSF group(n=43)and non-CSF group(n=196).The corrected thrombolysis in myocardial infarction(TIMI)frame count(CTFC)in the three major coronary branches of left anterior descending(LAD),left circumflex artery(LCX)and right coronary artery(RCA)were recorded.Logistics regression analysis was used to evaluate the risk factors for CSF occurrence during PCI in patients with CHD.Results:The CTFC values of LAF,LCX and RCA in CSF group were higher than those in N-CSF group(P<0.05).The prevalence rate of hypertension and diabetes and the levels of preoperative Hb,hs-CRP and cTnI in CSF group were higher than those in N-CSF group(P<0.05).Hypertension,diabetes,and preoperative high levels of Hb,hs-CRP and cTnI were independent risk factors for CSF during PCI(OR=1.861,1.782,2.447,2.540 and 3.068,P<0.05).Conclusion:Hypertension,diabetes and preoperative Hb,hs-CRP and cTnI levels can affect the occurrence of CSF during PCI.Clinical prevention and control measures should be taken to improve the prognosis of CHD patients.