PCI冠状动脉穿孔风险因素及治疗策略

发布时间：2018-07-13 19:38

【摘要】：背景：目前随着PCI治疗冠心病数量的增多，冠状动脉穿孔（CAP）的发生也随之增多，CAP作为一种少见但严重的并发症也越来越受到临床介入医生的重视。CAP受到很多因素的影响，但目前国内研究多为散发病例报道，国外研究结果相互矛盾，治疗手段缺乏统一标准。本研究通过回顾性分析方法，以期为冠状动脉穿孔的防治积累更多的理论支持。目的：探讨PCI过程中冠状动脉穿孔的发病率、危险因素和治疗策略。方法：本研究回顾了吉林大学白求恩第一医院心血管中心2011年1月到2015年1月住院接受PCI的11853例患者，其中男8356例，女3497例。发现冠状动脉穿孔病人41例，其中男25例，女16例。余下11812例中随机抽取105例，作为正常对照组，对其进行临床回顾性分析，包括病人基本临床资料、介入手术操作及治疗策略相关资料。结果： ①总发生率为0.35%，，死亡率4.88%。②单因素分析结果显示：穿孔组与未穿孔组在年龄（P=0.007）、B2+C类病变（P＜0.001）、重度钙化病变（P=0.005）、慢性完全闭塞病变（P＜0.001）、小血管病变（P=0.011）、多支血管病变（P=0.003）、前降支病变（P=0.023）间差异具有统计学意义（P＜0.05）。多元Logistic回归分析显示：年龄增加（OR1.05；95%CI1.002-1.101）、重度钙化病变（OR3.08；95%CI1.252-7.558）、慢性完全闭塞病变（OR2.80；95%CI1.083-7.225）、前降支病变（OR2.56；95%CI1.098-5.946）是冠状动脉穿孔的独立危险影响因素。③冠状动脉穿孔多与球囊（43.90%）和导丝(41.46%)操作有关。④球囊低压扩张、栓塞、覆膜支架植入、心包穿刺引流、血液回输和紧急外科手术是冠状动脉穿孔的有效治疗方法。结论： ①冠状动脉穿孔作为PCI并发症发生率低。②穿孔组与未穿孔对照组在年龄、B2+C类病变、重度钙化病变、慢性完全闭塞病变、小血管病变、多支血管病变、前降支病变组间差异具有统计学意义。③年龄增加、重度钙化病变、慢性完全闭塞病变、前降支病变是冠状动脉穿孔的独立危险因素。④经球囊低压扩张、栓塞、覆膜支架植入、心包引流、血液回输等治疗后其预后良好。
[Abstract]:Background:
At present, with the increase of the number of coronary heart disease (PCI), the incidence of coronary artery perforation (CAP) is also increasing. As a rare but serious complication, CAP is becoming more and more seriously affected by the attention of clinical interventional doctors. However, the domestic research is mostly reported in scattered cases, and the results of foreign research are contradictory and treatment. There is a lack of uniform standard. This study provides a more theoretical support for the prevention and treatment of coronary artery perforation through retrospective analysis.
Objective:
Objective to investigate the incidence, risk factors and treatment strategies of coronary artery perforation during PCI.
Method:
This study reviewed 11853 patients who were hospitalized in the cardiovascular center of Bethune First Hospital of Jilin University from January 2011 to January 2015, including 8356 males and 3497 females. 41 cases of coronary artery perforation were found in 25 men and 16 women. 105 of the remaining 11812 cases were randomly selected as the normal control group, and the clinical retrospective was reviewed. Analysis included basic clinical data, interventional operation and treatment strategy.
Result:
(1) the total incidence was 0.35%, and the single factor analysis of mortality 4.88%. showed that the difference in age (P=0.007), B2+C type lesion (P < 0.001), severe calcification (P=0.005), chronic complete occlusion (P < 0.001), small vascular disease (P=0.011), multiple vessel lesion (P=0.003), and anterior descending branch (P=0.023) in the perforation group and the non perforation group were in general. Study significance (P < 0.05). Multivariate Logistic regression analysis showed that age increased (OR1.05; 95%CI1.002-1.101), severe calcification (OR3.08; 95%CI1.252-7.558), chronic complete occlusion (OR2.80; 95%CI1.083-7.225), and anterior descending lesion (OR2.56; 95% CI1.098-5.946) were independent risk factors for coronary artery perforation. Multiple pulse perforation is related to the operation of balloon (43.90%) and guide wire (41.46%). 4. Balloon dilatation, embolism, stent implantation, pericardial drainage, blood transfusion and emergency surgery are effective methods for the treatment of coronary artery perforation.
Conclusion:
(1) the incidence of coronary artery perforation as a PCI complication was low. (2) the differences in age, B2+C, severe calcification, chronic complete occlusion, small vascular lesions, multiple vessel lesions, and anterior descending lesions were statistically significant in the group of perforation and non perforation. Anterior descending lesion is an independent risk factor for coronary artery perforation. (4) the prognosis is good after balloon dilatation, embolization, stent implantation, pericardial drainage and blood transfusion.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.4

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