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目的:评估植入支架长度对围手术期心肌梗死的预测意义。方法:选择2005年6月到2009年2月解放军第454医院医院及长海医院341名冠心病患者,共植入351枚雷帕霉素药物支架,根据植入支架数目分为单个支架组(22-36mm)及重叠支架组(>36mm);根据植入支架长度分四组:①28-36mm②37-59mm③60-80mm④>80mm。观察支架植入后的急性并发症,术后心电图变化和术后1周内心肌肌钙蛋白的变化。结果:1.手术成功率达98.9%,急性并发症发生率为6.1%。住院期间主要不良心血管事件(MACE)发生率达到14.1%。2.根据植入单个支架组与重叠支架组比较,重叠支架组(>36mm)术后肌钙蛋白I(TNI)显著高于单个支架组(22-36mm):6.0%VS1.1%,P<0.05;而在住院期间MACE发生率上前者也明显高于后者:11.6%VS5.6%,P<0.05。3.在支架长度分组中发现支架长度>60mm组发生围手术期并发症及MACE事件明显高于28-36mm组,P<0.05;其余组间未见显著差异。结论:重叠支架植入方法及植入支架长度>60mm明显增加术后心肌损伤标志物释放,增加围手术期非Q波心肌梗死的发生率及住院期间MACE事件发生率。
OBJECTIVE: To evaluate the predictive value of implantable stent length for perioperative myocardial infarction. METHODS: A total of 351 rapamycin-eluting stents were implanted in 341 Hospital of the 454th People’s Liberation Army and Changhai Hospital from June 2005 to February 2009. A total of 351 rapamycin- -36mm) and overlapping stent group (> 36mm); according to the length of the implantable stent divided into four groups: ①28-36mm②37-59mm③60-80mm④> 80mm. Acute complications after stent implantation, postoperative ECG changes and changes of cardiac troponin within 1 week after operation were observed. Results: 1. Surgical success rate was 98.9%, the incidence of acute complications was 6.1%. The incidence of major adverse cardiovascular events (MACE) during hospitalization reached 14.1%. According to the implantation group and the stent group, the troponin I (TNI) in the stent group (> 36mm) was significantly higher than that in the single stent group (22-36mm): 6.0% vs 1.1%, P <0.05; while the incidence of MACE during hospitalization was also significantly higher than the latter: 11.6% vs5.6%, P <0.05.3. Peripheral complications were found in the group of stent length> 60mm MACE events were significantly higher than the 28-36mm group, P <0.05; no significant difference between the other groups. CONCLUSIONS: Overlapping stent implantation and implantation of stent length> 60 mm significantly increase postoperative myocardial injury marker release and increase the incidence of perioperative non-Q wave myocardial infarction and incidence of MACE during hospitalization.