冠心病经皮冠状动脉介入治疗术后严重出血的危险因素分析及预后观察

Analysis of the risk factors of severe bleeding and prognosis observation after percutaneous coronary intervention among patients with heart disease

目的对冠心病经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后严重出血的危险因素进行分析,并观察患者预后。方法回顾性分析河北联合大学附属医院2010-2011年收治的559例经PCI术后患者的临床资料,并进行临床随访。应用PEMS 3.1统计软件进行数据处理,采用t检验和χ2检验,应用logistic回归分析筛选危险因素,P<0.05为差异有统计学意义。结果本组559例患者经PCI后,发生严重出血24例,发生率4.29%。高龄(OR=1.257)、女性(OR=1.984)、有胃部疾病(OR=2.175)、使用大规格鞘管(OR=2.138)、多次进行球囊扩张(OR=2.586)、使用血管闭合器(OR=3.586)是严重出血发生的独立危险因素(P<0.05)。出血组心脏不良事件(MACE)发生率(20.83%)及病死率(8.33%)均明显高于无出血组(4.67%和1.31%),差异有统计学意义(P<0.05)。结论 PCI术前应充分进行风险评估,根据年龄、体质量及患者自身病理情况制定个体化的治疗方案,术后进行密切观察,对相关危险因素进行重点关注,避免严重出血的发生。

Objective To analyze the risk factors of severe bleeding after percutaneous coronary intervention(PCI) among patients with coronary heart disease and observe the prognosis of these patients.Methods This study was a retrospectively study using clinical data and paticipants were interviewed again at study period.559 patients treated by PCI in the Affiliated Hospital of Hebei United University between 2010 and 2011 were included in this study.T test,χ2test and logistic regression were conducted through PEMS 3.1 statistic software.P<0.05 was considered statistically significant.Results 24 cases occurred severe bleeding,and the incidence was 4.29% among these patients.Higher age(OR=1.257),female(OR=1.984),stomach disorders(OR=2.175),usage of large- sized sheath(OR=2.138),repeated balloon dilation(OR=2.586),usage of vascular closure device(OR=3.586) were all significant independent risk factors of severe bleeding(P<0.05).Incidence and mortality of major adverse cardiovascular events(MACE) among patients with hemorrhage were 20.83% and 8.33% respectively which were higher than those without hemorrhage(4.67% and 1.31%),and the difference was statistically significant(P<0.05).Conclusions To avoid serious bleeding,risk assessments should be fully carried out before PCI; individualized treatments should be developed according to patient's age,Body Mass Index(BMI),and pathologic diagnosis; these relevant risk factors should be paid attention to closely.