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目的分析冠心病合并2型糖尿病患者的冠状动脉病变和经皮冠状动脉介入治疗(PCI)操作技术特点。方法对2002年1月至12月在阜外心血管病医院连续进行的1294例择期PCI并置入支架的患者进行回顾性分析,分析临床资料、介入治疗特点以及靶病变的位置、类型、长度等特征。结果糖尿病患者占20.8%,糖尿病组肥胖、女性、高血压、血脂异常、既往PCI患者的比例均较非糖尿病组高。糖尿病组右冠状动脉、双支或三支血管病变、高危险型病变显著多于非糖尿病患者。糖尿病组的平均治疗病变数及置入支架平均数均显著多于非糖尿病组患者(分别为1.63±0.82处比1.51±0.77处,1.66±0.84个比1.51±0.81个,P均<0.05)。糖尿病组术前狭窄程度、预扩张球囊平均长度、最大直径、最大充盈压力以及最长充盈时间均值都显著大于非糖尿病组[分别为91.00%±6.62%比89.81%±6.64%,17.07±6.31mm比16.07±7.28mm,2.30±1.11mm比2.12±0.94mm,996±444kPa(即9.86±4.40atm)比914±480kPa(即9.05±4.75atm),20.94±14.69s比18.26±14.65s,P均<0.05],而所置入支架平均直径则较小(3.15±0.47mm比3.23±0.43mm,P<0.05),但其他技术特征两组间差异无统计学意义(P>0.05)。糖尿病组与非糖尿病组间的PCI操作成功率、临床成功率差异无统计学意义(P>0.05)。结论冠心病合并2型糖尿病患者冠状动脉受累范围广,高危险型病变显著多于非糖尿病患者,在有选择的病例,PCI仍是治疗合并糖尿病的冠心病患者的有效手段。
Objective To analyze the characteristics of coronary artery disease and percutaneous coronary intervention (PCI) in patients with coronary heart disease and type 2 diabetes mellitus. Methods A retrospective analysis of 1,294 patients undergoing elective PCI and stent placement in Fu Wai Hospital from January 2002 to December 2002 was conducted. The clinical data, the characteristics of interventional therapy and the location, type and length of the target lesion were analyzed. And so on. Results 20.8% of patients with diabetes mellitus, obesity, diabetes, hypertension, dyslipidemia, the proportion of patients with previous PCI were higher than non-diabetic patients. Diabetic patients with right coronary artery, double or triple vessel disease, high-risk type lesions were significantly more than non-diabetic patients. The average number of treated lesions and the average number of stents in diabetic patients were significantly higher than those in non-diabetic patients (1.63 ± 0.82 vs 1.51 ± 0.77, 1.66 ± 0.84 vs 1.51 ± 0.81, P <0.05, respectively). Preoperative stenosis, average length of pre-dilated balloon, maximum diameter, maximum filling pressure and maximum filling time were significantly greater in diabetic patients than in non-diabetic patients [91.00% ± 6.62% vs 89.81% ± 6.64%, 17.07 ± 6.31 mm ratio of 16.07 ± 7.28 mm, 2.30 ± 1.11 mm to 2.12 ± 0.94 mm, 996 ± 444 kPa (ie 9.86 ± 4.40 atm) to 914 ± 480 kPa (ie 9.05 ± 4.75 atm), 20.94 ± 14.69 s to 18.26 ± 14.65 s, P (P <0.05). However, the average diameter of stent was smaller (3.15 ± 0.47mm vs 3.23 ± 0.43mm, P <0.05), but there was no significant difference in other technical characteristics between the two groups (P> 0.05). The success rate and clinical success rate of PCI between diabetic group and non-diabetic group had no significant difference (P> 0.05). Conclusions Coronary artery involvement in patients with type 2 diabetes mellitus and coronary heart disease has a wide range of coronary artery involvement, and the number of high-risk patients is significantly higher than that of non-diabetic patients. In selected cases, PCI is still an effective treatment for patients with coronary artery disease.