刘一飞,康伊,艾冠男,王兆丰,徐培,张玉婕,杨晓旭,顾崇怀,赵昕,任丽丽

• 1:锦州医科大学北部战区总医院研究生培养基地
• 2:北部战区总医院心血管内科
• 3:清华大学第一附属医院心脏中心
• 4:沈阳医学院附属第二医院心血管内科

摘要(Abstract)：

目的回顾性分析首次手术方式对冠心病患者短期(1个月)内行两次经皮冠状动脉介入治疗(PCI)接触对比剂后,围术期对比剂诱导的急性肾损伤(CI-AKI)发生情况及远期预后的影响。方法回顾性分析2010年1月至2015年1月就诊于北部战区总医院心内科且30 d内两次应用对比剂的冠心病患者601例,按照首次接触对比剂的手术方式分为:A组(首次手术方式为急诊PCI,113例)和B组(首次手术方式为择期PCI,488例)。比较两组临床特点、围术期CI-AKI发生率及相关危险因素,随访1年患者主要不良心血管事件(MACE,包括心原性死亡、再发心肌梗死、支架内再狭窄、支架内血栓形成)。结果 A组ST段抬高型心肌梗死患者、吸烟者比例和入院心率均高于B组;B组患者年龄、入院收缩压均高于A组,差异均有统计学意义(均P<0.05)。A组利尿药使用比例高于B组;钙通道阻滞药、血管紧张素转换酶抑制药/血管紧张素Ⅱ受体拮抗药应用比例较B组低,差异均有统计学意义(P<0.05);A组患者估算的肾小球滤过率(e GFR)水平显著高于B组,差异有统计学意义(P<0.001)。A组第1次术后CI-AKI发生率、第2次术后CI-AKI发生率均显著高于B组,差异有统计学意义(P<0.001)。logistic多因素回归分析显示:年龄(OR 1.058,95%CI 1.000～1.118,P=0.049)是首次手术方式为急诊PCI的患者第1次术后CI-AKI发生的独立危险因素;eGFR(OR 1.015,95%CI1.000～1.030,P=0.048)是首次手术方式为急诊PCI的患者第2次术后CI-AKI的独立危险因素。随访1年,A组MACE发生率高于B组,但差异无统计学意义。A组支架内再狭窄事件发生率高于B组(P=0.037)。结论首次急诊PCI患者,短期内行两次PCI接触对比剂后围术期CI-AKI发生率均高于择期PCI患者。两种手术方式对于冠心病患者远期MACE事件发生率无明显影响。

关键词(KeyWords)： 冠状动脉粥样硬化性心脏病;急诊经皮冠状动脉介入治疗;对比剂诱导急性肾损伤;主要不良心血管事件

Abstract:

Keywords:

基金项目(Foundation): 辽宁省重点研发计划项目（2018225001）;; 立信扬帆优化抗栓科研基金（BJUHFCSOARF201801-05）

作者(Author): 刘一飞,康伊,艾冠男,王兆丰,徐培,张玉婕,杨晓旭,顾崇怀,赵昕,任丽丽

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