摘要
目的 探讨经皮冠状动脉介入治疗(PCI)在老年肌少症合并缺血性心肌病(1CM)患者治疗中的应用价值.方法 选取129例老年肌少症合并ICM患者作为研究对象,采用随机数字表法将其分为常规组64例和联合组65例,依据剔除标准筛选后,最终每组纳入55例患者.常规组接受常规药物治疗,联合组在此基础上接受PCI.比较2组入院时和出院1、3、6个月时的主观症状、血压[收缩压(SBP)、舒张压(DBP)]、美国纽约心脏病学会(NYHA)心功能分级、加拿大心血管病学会(CCS)心绞痛分级、左心室功能指标[左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)]、血清学指标[血清氨基末端脑钠肽前体(NT-proBNP)、心肌肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB)]、6 min步行距离(6MWD),并观察2组主要不良心血管事件(MACE)发生情况.结果 联合组55例患者PCI术中均植入1～3个支架,平均植入数量为(1.78±0.36)个,手术成功率为100.00％.2组出院1、3、6个月时胸痛、心悸、胸闷、乏力评分和SBP、DBP、NYHA心功能分级、CCS心绞痛分级均低于入院时,且联合组出院3、6个月时上述指标均低于常规组,差异有统计学意义(P＜0.05);2组出院1、3、6个月时LVEDD、LVESD均小于入院时,LVEF高于入院时,血清NT-proBNP、cTnT、CK-MB水平均低于入院时,且联合组出院3、6个月时LVEDD、LVESD小于常规组,LVEF高于常规组,血清NT-proBNP、cTnT、CK-MB水平低于常规组,差异有统计学意义(P＜0.05);2组出院1、3、6个月时6MWD均长于入院时,且联合组出院3、6个月时6MWD长于常规组,差异有统计学意义(P＜0.05);出院6个月时,联合组MACE发生率低于常规组,差异有统计学意义(P＜0.05).结论 PCI应用于老年肌少症合并ICM患者的治疗中,能够显著改善患者的主观症状和客观心功能指标,同时降低MACE发生率.
Abstract
Objective To explore the application value of percutaneous coronary intervention(PCI)in the treatment of elderly patients with sarcopenia and ischemic cardiomyopathy(ICM).Methods A total of 129 elderly patients with sarcopenia and ICM were selected as study subjects and randomly divided into conventional group(64 patients)and combined group(65 patients)using a random number table method.After screening based on exclusion criteria,55 patients were ulti-mately included in each group.The conventional group received conventional drug therapy,while the combined group received PCI in addition to conventional therapy.Subjective symptoms,blood pres-sure[systolic blood pressure(SBP),diastolic blood pressure(DBP)],New York Heart Association(NYHA)functional class,Canadian Cardiovascular Society(CCS)angina class,left ventricular function indicators[left ventricular end-diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),left ventricular end-systolic diameter(LVESD)],serological indicators[N-terminal pro-brain natriuretic peptide(NT-proBNP),cardiac troponin T(cTnT),creatine kinase-MB(CK-MB)],and 6-minute walk distance(6MWD)were compared between the two groups at admission and 1-,3-,and 6-month after discharge.Additionally,the incidence of major adverse cardiovascular events(MACE)was observed in both groups.Results All 55 patients in the combined group underwent PCI with implantation of 1 stent to 3 stents,with an average of(1.78±0.36)stents implanted per patient,and the surgical success rate was 100.00％.At 1-,3-,and 6-month after discharge,the scores for chest pain,palpitations,chest distress,and fatigue,as well as SBP,DBP,NYHA func-tional class,and CCS angina class,were lower in both groups compared to admission.Furthermore,these indicators were lower in the combined group than in the conventional group at 3 and 6 months after discharge(P＜0.05).At 1-,3-,and 6-month after discharge,LVEDD and LVESD were smaller,LVEF was higher,and serum levels of NT-proBNP,cTnT,and CK-MB were lower in both groups compared to admission.Additionally,LVEDD,LVESD,and serum levels of NT-proBNP,cTnT,and CK-MB were lower,and LVEF values were higher in the combined group than those in the conventional group at 3 and 6 months after discharge(P＜0.05).The 6MWD was longer in both groups at 1-,3-,and 6-month after discharge compared to admission,and the combined group was longer than that in the conventional group at 3 and 6 months after discharge(P＜0.05).At 6 months after discharge,the incidence of MACE was lower in the combined group than in the conven-tional group(P＜0.05).Conclusion The application of PCI in the treatment of elderly patients with sarcopenia and ICM can significantly improve subjective symptoms and objective cardiac func-tion indicators,and reduce the incidence of MACE.
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