维持血液透析合并非ST段抬高型急性冠状动脉综合征患者行冠状动脉介入治疗临床效果观察

Clinical effect of percutaneous coronary intervention in maintenance hemodialysis patients combined with non-ST-segment elevation acute coronary syndrome

目的探讨维持血液透析合并非ST段抬高型急性冠状动脉综合征(NSTE-ACS)患者行经皮冠状动脉介入疗法(PCI)的安全性和有效性。方法回顾性分析2010年1月至2015年1月大连市中心医院52例维持血液透析合并NSTE-ACS患者的临床资料。其中,常规药物治疗25例(对照组),常规药物治疗联合PCI治疗27例(PCI组)。记录患者住院期间主要心血管不良事件(MACE)发生情况,包括出血、恶性心律失常、新发心力衰竭或加重、脑卒中和全因死亡。记录患者治疗后1个月内透析并发症,包括低血压、心律失常、心力衰竭和心绞痛。患者随访12个月,记录治疗后1、6和12个月MACE发生情况,包括心绞痛、心力衰竭和心源性死亡等。结果住院期间,PCI组恶性心律失常和新发心力衰竭或加重发生率明显低于对照组[18.5%(5/27)比44.0%(11/25)和7.4%(2/27)比32.0%(8/25)],差异有统计学意义(P<0.05);两组出血、脑卒中和全因死亡发生率比较差异无统计学意义(P>0.05)。PCI组治疗后1个月内透析并发症低血压、心律失常、心力衰竭和心绞痛发生率明显低于对照组[24.0%(6/25)比56.5%(13/23)、16.0%(4/25)比43.5%(10/23)、12.0%(3/25)比47.8%(11/23)和24.0%(6/25)比52.2%(12/23)],差异有统计学意义(P<0.05或<0.01)。随访结果显示,PCI组治疗后1、6和12个月心绞痛和心力衰竭发生率明显低于对照组[心绞痛:28.0%(7/25)比65.2%(15/23)、29.2%(7/24)比76.2%(16/21)和43.5%(10/23)比17/17;心力衰竭:16.0%(4/25)比43.5%(10/23)、8.3%(2/24)比33.3%(7/21)和21.7%(5/23)比10/17],差异有统计学意义(P<0.05或<0.01);两组治疗后1和6个月心源性死亡发生率比较差异无统计学意义(P>0.05),PCI组治疗后12个月心源性死亡发生率明显低于对照组[8.6%(2/23)比9/17],差异有统计学意义(P<0.01)。结论维持血液透析合并NSTE-ACS患者行PCI治疗是安全、有效的。

Objective To explore the safety and efficiency of percutaneous coronary intervention(PCI)in maintenance hemodialysis patients combined with non-ST-segment elevation acute coronary syndrome(NSTE-ACS).Methods The clinical data of 52 maintenance hemodialysis patients combined with NSTE-ACS from January 2010 to January 2015 in Dalian Central Hospital were retrospectively analyzed.Among of them,25 patients were treated with common drugs(control group),and 27 patients were treated with common drugs combined with PCI(PCI group).The major adverse cardiac events(MACE)duration of hospital stay were record,including hemorrhage,malignant arrhythmia,new heart failure or aggravation,stroke and all-cause death.The dialysis complications within 1 month after treatment were recorded,including hypotension,arrhythmia,heart failure and angina pectoris.The patients were followed up for 12 months,the MACE 1,6 and 12 months after treatment were recorded,including angina pectoris,heart failure and cardiac death.Results Duration of hospital stay,the incidences of malignant arrhythmia and new heart failure or aggravation in PCI group were significantly lower than those in control group:18.5%(5/27)vs.44.0%(11/25)and 7.4%(2/27)vs.32.0%(8/25),and there were statistical differences(P<0.05);there were no statistical difference in the incidences of hemorrhage,stroke and all-cause death between the two groups(P>0.05).The incidences of dialysis complications such as hypotension,arrhythmia,heart failure and angina pectoris within 1 month after treatment in PCI group were significantly lower than those in control group:24.0%(6/25)vs.56.5%(13/23),16.0%(4/25)vs.43.5%(10/23),12.0%(3/25)vs.47.8%(11/23)and 24.0%(6/25)vs.52.2%(12/23),and there were statistical differences(P<0.05 or<0.01).The follow-up results showed that the incidences of angina pectoris and heart failure 1,6 and 12 months after treatment in PCI group were significantly lower than those in control group,angina pectoris:28.0%(7/25)vs.65.2%(15/23),29.2%(7/24)vs.76.2%(16/21)and 43.5%(10/23)vs.17/17,heart failure:16.0%(4/25)vs.43.5%(10/23),8.3%(2/24)vs.33.3%(7/21)and 21.7%(5/23)vs.10/17,and there were statistical differences(P<0.05 or<0.01);there was no statistical difference in the incidence of cardiac death 1 and 6 months after treatment between two groups(P>0.05),the incidence of cardiogenic death 12 months after treatment in PCI group was significantly lower than that in control group:8.6%(2/23)vs.9/17,and there was statistical difference(P<0.01).Conclusions PCI is safe and effective for maintenance hemodialysis patients combined with NSTE-ACS.