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目的:分析冠状动脉搭桥术后(CABG)的老年冠心病患者再发心绞痛,给予不同治疗方式(优化药物治疗、介入治疗)后心脏血流动力学及神经内分泌变化,以及评价CABG后再发心绞痛介入治疗的近期效果。方法:收集2007-01-2012-12在本院CABG后近期复发心绞痛患者的入院临床基线资料,根据是否行介入手术,分为两组:第1组在优化药物的基础上给予桥血管或者原位血管介入治疗(PCI组),第2组给予优化药物治疗(ODT组)。3个月后随访心脏相关辅助检查结果、心功能、主要不良心血管事件(MACE)以及患者预后情况。结果:PCI组肾素、血管紧张素Ⅱ、醛固酮、去甲肾上腺素、肾上腺素、血红蛋白、肌酐、脑钠肽、左室舒张内径、左室射血分数方面均低于ODT组,差异有统计学意义(P<0.05)。多因素Logistic回归分析,血红蛋白水平是胸痛症状的相关因素(B:-3.991,S.E:1.940,Wals:4.231,P=0.04,OR:0.018,95%CI:0.000~0.828)。采用Pearson相关分析了解心脏功能与神经内分泌水平的相关性,二者具有统计学意义(P<0.05)。结论:PCI较ODT显著降低心脏相关的不良因子水平;PCI总有效率优于ODT组;血红蛋白水平与临床胸痛症状有关;心脏功能与神经内分泌水平有一定的相关性。
Objective: To analyze the changes of cardiac hemodynamics and neuroendocrine changes in elderly patients with coronary heart disease after coronary artery bypass grafting (CABG) with angina pectoris given different treatment modalities (optimal drug treatment and interventional therapy) Recent effects of interventional therapy. Methods: The clinical baseline data of admission for patients with recurrent angina pectoris after CABG in our hospital from January 2007 to December 2012 were collected and divided into two groups according to whether they were involved in the interventional operation: group 1 was given the bridge blood vessel or the original (PCI group), Group 2 was given optimized drug treatment (ODT group). Cardiac related examinations, cardiac function, major adverse cardiovascular events (MACE), and patient outcomes were followed up 3 months later. Results: The levels of renin, angiotensin Ⅱ, aldosterone, norepinephrine, epinephrine, hemoglobin, creatinine, brain natriuretic peptide, left ventricular diastolic diameter and left ventricular ejection fraction in PCI group were significantly lower than those in ODT group Significance (P <0.05). Multivariate logistic regression analysis showed that hemoglobin level was a related factor of chest pain (B: -3.991, S.E: 1.940, Wals: 4.231, P = 0.04, OR: 0.018, 95% CI: 0.000-0.828). Pearson correlation analysis to understand the correlation between cardiac function and neuroendocrine level, both with statistical significance (P <0.05). Conclusion: Compared with ODT, PCI can significantly reduce the level of cardiac-related adverse factors. The total effective rate of PCI is better than that of ODT group. The hemoglobin level is related to the clinical symptoms of chest pain. There is a certain correlation between cardiac function and neuroendocrine level.