血管性疾病介入中血管再通顺应性及术后生化指标的对比研究

A comparative study of vascular recanalization compliance and postoperative biochemical indexes during vascular disease intervention

目的探讨经皮冠状动脉介入治疗(PCI)术中血管再通顺应性及术后生化指标变化。方法选取2019年3月—2021年3月341例接受PCI治疗的不稳定型心绞痛和急性心肌梗死患者,根据是否出现早期支架贴壁不良(ESM)将患者分为ESM组(n=35)、无ESM组(n=306),比较两组一般资料、支架内表面与所在血管内表面距离、偏心指数及全血高切黏度、全血低切黏度、血浆黏度、血小板聚集率(PAR)、抗凝血酶Ⅲ(ATⅢ)、血小板抑制率(PIR)、D-二聚体(D-D)、国际标准化比值(INR)、早期与晚期心血管相关不良事件发生率。结果ESM组支架内表面与所在血管内表面距离、偏心指数高于无ESM组(P<0.05);两组PCI后与PCI前全血高切黏度、全血低切黏度、血浆黏度比较,差异无统计学意义(P>0.05);ESM组PCI后PAR高于PCI前,ATⅢ低于PCI前(P<0.05);无ESM组PCI后PAR低于PCI前,PIR高于PCI前(P<0.05);无ESM组PCI后PAR低于ESM组,ATⅢ、PIR高于ESM组(P<0.05);两组PCI即刻TIMI血流分级及早期心血管相关不良事件比较,差异无统计学意义(P>0.05);随访12个月,ESM组26例ESM消失,9例ESM持续存在;无ESM组出现15例获得性支架贴壁不良,与无晚期支架贴壁不良(LSM)患者相比,LSM患者远期心血管相关不良事件发生率明显升高(P<0.05)。结论PCI术后ESM发生率较高,可影响凝血功能指标,但不会影响短期内心脏不良事件的发生;ESM随访中可消失,也可持续存在,无ESM患者术后亦存在发生获得性支架贴壁不良的风险,ESM持续存在及获得性支架贴壁不良将明显增加远期心脏不良事件发生率。

Objective To investigate the intraoperative vascular recanalization compliance and postoperative biochemical changes of percutaneous coronary intervention(PCI).Methods A total of 341 patients with unstable angina pectoris and acute myocardial infarction who received PCI from March 2019 to March 2021 were selected.According to whether early stent malapposition(ESM)occurred,the patients were divided into ESM group(n=35),non-ESM group(n=306),the general information,distance between the inner surface of the stent and the inner surface of the blood vessel,eccentricity index,whole blood high shear viscosity,whole blood low shear viscosity,plasma viscosity,platelet aggregation rate(PAR),ThrombinⅢ(ATⅢ),platelet inhibition rate(PIR),D-dimer(DD),international normalized ratio(INR),early and late cardiovascular-related adverse events were compared between the two groups.Results The distance and eccentricity index between the inner surface of the stent and the inner surface of the blood vessel in the ESM group were higher than those in the non-ESM group(P<0.05).There was no statistical significance(P>0.05);PAR after PCI in ESM group was higher than before PCI,and ATⅢwas lower than before PCI(P<0.05);PAR after PCI in non-ESM group was lower than that before PCI,and PIR was higher than that before PCI(P<0.05);PAR after PCI in the non-ESM group was lower than that in the ESM group,and ATⅢand PIR were higher than those in the ESM group(P<0.05).After 12 months of follow-up,26 cases of ESM disappeared in the ESM group,and 9 cases of ESM persisted;There were 15 cases of acquired stent malapposition in the non-ESM group.Compared with the non-ESM patients,the ESM patients had a significantly higher incidence of long-term cardiovascular-related adverse events(P<0.05).Conclusion The incidence of ESM after PCI is high,which can affect coagulation function indicators,but will not affect the occurrence of adverse cardiac events in the short term;ESM can disappear during follow-up,and it can persist,and patients without ESM also have acquired stents after surgery.The risk of malapposition,persistence of ESM and acquired stent malapposition will significantly increase the incidence of long-term adverse cardiac events.