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目的对比分析药物洗脱支架介入治疗和冠脉旁路手术治疗冠状动脉左主干病变的近远期疗效及对患者生存质量的改善。方法前瞻性选取华中科技大学同济医学院附属同济医院心脏大血管外科2013年1月至2015年1月期间收治的150例冠状动脉左主干病变患者为研究对象,根据手术方案将其分为DES组(90例)和CAGB组(60例),分别行介入药物洗脱支架置入术和冠脉旁路手术,并对两组患者进行随访,对比分析近远期疗效及生存质量情况。结果 PCI-DES术成功率为100.00%,住院期间两组患者均未发生急性心肌梗死、脑血管及死亡;随访终点DES组靶病变血运重建率(18.89%)明显高于CAGB组(6.67%)(P<0.05),主要心血管事件发生率(15.56%)明显低于CAGB组(30.00%,P<0.05),其余各项差异无统计学意义(P均>0.05);两组患者术后3个月、随访末健康调查简表(SF-36量表)中除总体健康评分外其他7个维度方面评分较术前均明显提高(P均<0.05),CABG组在机体疼痛、躯体功能2个维度方面明显高于DES组(P均<0.05)。结论药物洗脱支架和冠脉旁路手术治疗冠脉左主干病变均可获得满意的近远期疗效,临床实践要综合评估患者的病情及手术风险,制定最佳的手术方案以减轻患者的临床症状,延长生存期并改善生存质量。
Objective To compare the short-term and long-term effects of interventional therapy with drug-eluting stents and coronary artery bypass grafting in the treatment of left main coronary artery disease and to improve the quality of life of the patients. Methods A prospective study of 150 patients with left main coronary artery disease who were admitted to Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology from January 2013 to January 2015 was prospectively selected and divided into DES group (90 cases) and CAGB group (60 cases) were treated with PCI and coronary artery bypass grafting respectively. The two groups were followed up to compare the short-term and long-term efficacy and quality of life. Results The success rate of PCI-DES was 100.00%. No acute myocardial infarction, cerebrovascular disease and death occurred in the two groups during hospitalization. The target rate of revascularization in DES group was significantly higher than that in CAGB group (6.67% ) (P <0.05). The incidence of major cardiovascular events (15.56%) was significantly lower than that of CAGB group (30.00%, P <0.05), and the other differences were not statistically significant At the end of the follow-up period, scores of other seven dimensions in the SF-36 questionnaire except the general health score were significantly higher than those before the operation (all P <0.05). In the CABG group, pain scores in the body, Function 2 dimensions was significantly higher than the DES group (P all <0.05). Conclusion The drug-eluting stents and coronary artery bypass grafting can achieve satisfactory short-term and long-term effects in the treatment of left main coronary artery disease. The clinical practice should comprehensively assess the patient’s condition and surgical risk, and develop the best surgical plan to reduce the clinical Symptoms, prolong survival and improve quality of life.