急性冠脉综合征患者PCI术后血管并发症发生情况及其影响因素分析

Occurrence of vascular complications and its influencing factors in patients with acute coronary syndrome after PCI

目的:分析急性冠脉综合征(ACS)患者经皮冠状动脉介入术(PCI)后血管并发症发生情况及其影响因素。方法:选取2018年2月~2020年5月医院心血管内科行PCI手术的ACS患者496例为研究对象,依据术后3个月是否发生血管并发症将其分为观察组(n=124,术后3个月发生血管并发症)、 对照组(n=372,术后3个月未发生血管并发症),对比两组临床资料,分析血管并发症的影响因素。结果:本研究中共124例ACS患者在PCI术后发生血管并发症(25.00%),其中以桡动脉痉挛、局部出血、局部血肿、上肢肿胀及疼痛较常见,发生率分别为11.90%、6.65%、5.85%;单因素及多因素Logistic回归分析显示,年龄、病程、急诊PCI、手术持续时间、抗凝药物使用不当、手术部位管理不规范是ACS患者PCI术后发生血管并发症的危险因素,而经桡动脉途径入路、规范的手术期患者管理、规律服药、健康宣教是其保护因素。结论:ACS患者易受年龄、病程、急诊PCI、手术持续时间、抗凝药物使用不当、手术部位管理不规范而在PCI术后发生血管并发症,采用经桡动脉途径入路、合理使用抗凝药物、规律服药及规范的手术期患者管理、健康宣教可减少血管并发症发生。

Objective To analyze the occurrence of vascular complications and its influencing factors in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI).Methods A total of 496 patients with ACS who underwent PCI in the Hospital from February 2018 to May 2020 were selected for the study and were divided into observation group (n=124,vascular complications at 3 months after operation) and control group (n=372,no vascular complications at 3 months after operation) according to whether there were vascular complications at 3 months after operation or not.The clinical data of the two groups were compared,and the influencing factors for vascular complications were analyzed.Results 124 patients with ACS had vascular complications after PCI (25.00%).Among complications,local bleeding,local hematoma,upper extremity swelling and pain were more common with incidence rates of 11.90%、6.65%、5.85% respectively.Univariate and multivariate Logistic regression analysis showed that age,disease duration,emergency PCI,operative time,improper use of anticoagulant drugs,irregular management of surgical sites were risk factors for vascular complications in patients with ACS after PCI,and transradial approach,regular medication,standardized surgical management,and health education were the protective factors.Conclusions Patients with ACS are susceptible to vascular complications after PCI due to age,disease duration,emergency PCI and operative time.The use of trans-radial approach,rational use of anticoagulant drugs,regular medication and standardized surgical management,health education can reduce vascular complications.