择期冠状动脉介入治疗2868例并发症分析

Complications in selective percutaneous coronary interventions:analysis of 2868 cases

目的 探讨择期经皮冠状动脉介入治疗 (PCI)并发症发生率、危险因素和防治措施。方法 应用回顾性调查的方法对 1987年 10月至 2 0 0 0年 12月间 2 86 8例PCI的并发症类型、发生率及其年度分布特征进行统计分析 ,并分析与PCI并发症有关的危险因素和防治措施。结果 在研究期间 ,共进行 2 86 8例介入治疗。介入治疗总的并发症发生率为 8 30 % ( 6 33%～ 2 0 0 0 % )。手术相关病死率为 0 0 7%。主要并发症包括非致死性Q波心肌梗死 ( 0 17% )、急诊冠脉旁路移植术( 0 10 % )、冠脉夹层 ( 2 5 8% )、冠脉急性闭塞 ( 1 99% )、冠脉血栓形成 ( 0 38% )、冠脉痉挛 ( 1 32 % )、冠脉穿孔 ( 0 31% )、严重心律失常 ( 0 6 3% )、造影剂严重过敏反应 ( 0 0 7% )、周围血管并发症( 0 90 % )和心力衰竭 ( 0 10 % )。并发症发生率至 2 0世纪 90年代中期后明显降低。与PCI并发症发生有关的独立危险因素包括 :不稳定性心绞痛、冠脉多支病变和心力衰竭。结论 随着经验积累 ,PCI并发症发生率降低。本组并发症发生率较文献报道低 ,可能与严格掌握适应证 。

Objective This report provides analysis of the complication rates, the risk factors, prevention and treatments of the complications of selective coronary interventions Methods The types, the incidence, and the annual distribution characteristics of the complications in 2 868 cases of coronary interventions performed from October 1987 to December 2000 were reviewed, and the risk factors, prevention and treatments of the complications were analyzed Results During the study period, 2 868 procedures of percutaneous coronary interventions (PCI) were performed The total complication rate of PCI was 8 30%(6 33%-20 00%) The procedure related mortality rates were 0 07% The complications included non fatal Q wave myocardial infarctions(0 17%), coronary artery dissecting(2 58%), acute coronary artery occlusion(1 99%), coronary artery thrombosis(0 38%), coronary artery spasm(1 32%), coronary artery perforation(0 31%), severe arrhythmia(0 63%), severe contrast allergic reaction(0 07%), peripheral vascular complication(0 90%), and heart failure(0 10%) Emergent coronary artery bypass surgery(CABG) was required in 0 10% of the patients with PCI The independent risk factors of the complications of PCI included unstable angina, coronary multivessel disease, and heart failure Conclusions The complication rates of PCI decreased with the accumulation of experiences The complication rates in this group of patients are lower than the reported ones This result is probably due to strictly selecting the indication, actively preventing and treating the complications