冠状动脉旁路移植术与PCI对冠心病合并糖尿病患者的近远期疗效比较

Short-term and long-term curative effects of coronary artery bypass grafting and PCI on patients with coronary heart disease complicated with diabetes mellitus

目的比较冠状动脉旁路移植术(CABG)与经皮冠状动脉介入术(PCI)对合并糖尿病的冠心病患者的近远期疗效。方法抽取2018年1月至2019年9月太原钢铁集团有限公司总医院收治的90例冠心病合并糖尿病患者,按照不同血运重建方式分为CABG组(46例,CABG)和PCI组(44例,PCI)。比较两组术前及术后心功能包括左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室射血分数(LVEF),生命质量包括西雅图心痛量表(SAQ),比较两组住院期间、术后12个月心血管事件(MACE)发生情况。结果术后,两组LVEDD、LVESD水平低于术前,LVEF水平高于术前(P<0.05);术前及术后两组VEDD、LVESD、LVEF水平比较差异未见统计学意义(P>0.05)。术后,两组SAQ评分低于术前(P<0.05),术前及术后两组SAQ评分比较差异未见统计学意义(P>0.05)。住院期间,两组全因死亡、脑血管事件、非致死性心肌梗死发生率比较差异未见统计学意义(P>0.05)。术后12个月,两组患者全因死亡、心源性死亡、脑血管事件、非致死性心肌梗死、再次重建血运发生率比较差异未见统计学意义(P>0.05);CABG组再发心绞痛发生率低于PCI组(P<0.05)。结论 CABG与PCI均能够有效治疗冠心病合并糖尿病,改善患者生存质量,近期效果相似,但CABG远期效果较PCI好,能降低再发心绞痛发生率。

Objective To compare the short-term and long-term curative effects of coronary artery bypass grafting(CABG)and percutaneous coronary intervention(PCI)on patients with coronary heart disease complicated with diabetes mellitus.Methods Ninety patients with coronary heart disease and diabetes mellitus admitted to General Hospital of Taiyuan Iron and Steel Group from January 2018 to September 2019 were divided into CABG group(46 cases,CABG)and PCI group(44 cases,PCI)according to different revascularization methods.The cardiac function including left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),left ventricular ejection fraction(LVEF)and quality of life including Seattle Angina Questionnaire(SAQ)were compared between the two groups before and after surgery.The occurrence of major adverse cardiovascular events(MACE)of the two groups were compared during hospitalization and at 12 months after surgery.Results After surgery,the levels of LVEDD and LVESD in the two groups were significantly lower than those before surgery while the level of LVEF was significantly higher than that before surgery(P<0.05).There were no significant differences in the levels of VEDD,LVESD and LVEF between the two groups before and after surgery(P>0.05).After surgery,the SAQ scores of the two groups were significantly lower than those before surgery(P<0.05),and there were no significant differences in the SAQ scores between the two groups before and after surgery(P>0.05).During hospitalization,there were no significant differences in the incidence rates of all-cause death,cerebrovascular events and non-fatal myocardial infarction between the two groups(P>0.05).At 12 months after surgery,there were no significant differences in the incidence rates of all-cause death,cardiogenic death,cerebrovascular events,non-fatal myocardial infarction and revascularization between the two groups(P>0.05).The incidence rate of recurrent angina pectoris in CABG group was significantly lower than that in PCI group(P<0.05).Conclusions Both CABG and PCI can effectively treat coronary heart disease with diabetes mellitus and improve the quality of life,and they have similar short-term effect.However,CABG has a better long-term effect than PCI and can reduce the incidence rate of recurrent angina pectoris.