PCI对老年冠心病合并肾功能不全患者心、肾功能的影响

目的:研究经皮冠状动脉介入术(PCI)对老年冠心病(CHD)合并肾功能不全(RI)患者心、肾功能的影响。方法:选择本院2016年1月~2018年1月间收治的61例老年CHD+RI患者为研究组,同期本院的61例老年肾功能正常的CHD患者为冠心病对照组,两组均接受PCI治疗。对比两组PCI术中指标及治疗前后、肾功能。结果:术前:与冠心病对照组比较,研究组单支病变、AHA/ACC A型病变比例显著降低,多支病变、AHA/ACC B型、C型病变比例显著升高,P均=0.001;手术时间(84.37±9.87)min比(112.03±10.28)min]、置入支架数量(1.38±0.26)个比(2.16±0.31)个]和造影剂用量(139.62±20.05)ml比(185.47±20.18)ml]均显著升高,P均=0.001;与术前比较,术后研究组LVEF (54.05±5.85)%比(56.17±5.91)%]显著升高,但仍显著低于冠心病对照组(56.17±5.91)%比(58.43±6.12)%],P均<0.05;研究组LVESd (33.61±4.78)mm比(31.59±4.59)mm]显著缩小,但仍显著大于冠心病对照组(31.59±4.59)mm比(29.64±4.28)mm],LVEDd (52.16±1.97)mm比(50.24±1.98)mm]显著缩小,但仍显著大于冠心病对照组(50.24±1.98)mm比(49.23±2.09)mm]P<0.05或<0.01。无论术前术后,与冠心病对照组比较,研究组Scr、BUN、CysC水平均显著升高,GFR均显著降低,P均=0.001;CIN发生率(0比9.84%)、3个月内总的心血管不良事件发生率(6.56%比22.95%)均显著升高,P均<0.05。结论:PCI治疗对老年冠心病合并肾功能不全患者能够显著改善心功能,但其预后仍逊于老年冠心病肾功能正常的患者。

PCI Influence on cardiac and renal function in aged patients with coronary heart disease complicated renal insufficiency

Objective:To study influence of percutaneous coronary intervention(PCI)on cardiac,renal function in aged patients with coronary heart disease(CHD)complicated renal insufficiency(RI).Methods:A total of 61 aged CHD+RI patients treated in our hospital from Jan 2016 to Jan 2018 were regarded as research group,another 61 aged CHD patients with normal renal function in our hospital simultaneously were enrolled in CHD control group,and both groups received PCI.Indexes during PCI,cardiac and renal function before and after treatment were compared between two groups.Results:Before PCI,compared with CHD control group,there were significant reductions in percentages of single vessel coronary disease and AHA/ACC type A lesion,and significant rise in percentages of multiple vessel coronary disease,AHA/ACC type B and C lesion,P=0.001 all;significant rise in operation time(84.37±9.87)min vs.(112.03±10.28)min],number of implanted stents(1.38±0.26)vs.(2.16±0.31)]and contrast agent dose(139.62±20.05)ml vs.(185.47±20.18)ml]in research group,P=0.001 all.Compared with before PCI,LVEF (54.05±5.85)% vs.(56.17±5.91)%]significantly rose in research group after PCI,but still siguificantly lower than that of CHD control group (56.17±5.91)% vs.(58.43±6.12)%],P<0.05 all;LVESd (33.61±4.78)mm vs.(31.59±4.59)mm]significantly reduced in research group,but still significantly higher than that of CHD control group(31.59±4.59)mm vs.(29.64±4.28)mm],LVEDd(52.16±1.97)mm vs.(50.24±1.98)mm]significantly reduced in research group,but still significantly higher than that of CHD control group (50.24±1.98)mm vs.(49.23±2.09)mm ]P<0.05 or<0.01.No matter before or after PCI,compared with CHD control group,there were significant rise in levels of Scr,BUN and CysC,and significant reduction in GFR in research group,P=0.001 all.Compared with CHD control group,there were significant rise in incidence rate of CIN(0 vs.9.84%)and incidence rate of adverse cardiovascular events within three months(6.56% vs.22.95%)in research group,P<0.05 both.Conclusion:PCI can significantly improve cardiac function in aged CHD+RI patients,but their prognosis is still poorer than that of aged CHD patients with normal renal function.