经皮冠状动脉介入术后血管迷走反射风险预测模型的临床应用效果

Clinical application of a risk prediction model of vasovagal reflex syndrome after percutaneous coronary intervention:a single-center analysis

摘要:

目的 探讨经皮冠状动脉介入(PCI)术后血管迷走反射风险预测模型及优化升级救治流程对迷走反射发病率和救治时间的影响。方法 纳入2010年1月1日至2018年6月30日在解放军总医院第一医学中心心血管内科接受PCI手术患者。2010年1月1日至2016年6月30日手术患者共3550例,纳入常规组,其中161例发生血管迷走反射,接受常规流程救治,其中男性108例,年龄(57.92±10.42)岁；2016年7月1日至2018年6月30日手术患者共1574例,纳入优化组,其中13例发生血管迷走反射,接受优化升级救治流程,其中男性9例,年龄(53.01±14.78)岁。比较两组患者一般信息、临床资料、血管迷走反射的发生率、抢救成功率、抢救时间等。应用SPSS 20.0对数据进行统计分析。结果 年龄、性别、既往病史等临床资料2组间差异均无统计学意义。优化升级组迷走反射发生率明显低于常规组(0.83% vs 4.54%,P＜0.05),严重迷走反射的发病率亦明显低于常规组(0.13% vs 1.18%,P＜0.001)。优化升级救治流程明显缩短了抢救所用时间,提高了抢救成功率。优化组患者的焦虑程度明显减轻,住院期间医护质量的满意率明显提升,平均住院日也明显缩短[(2.82±1.09) vs(4.56±1.25)d,P＜0.05]。结论 PCI术后血管迷走反射风险预测模型及优化升级救治流能够降低术后迷走反射的发生率,缩短救治时间,有一定的临床应用价值。

Abstract:

Objective To explore the effect of risk prediction model of vasovagal reflex syndrome after percutaneous coronary intervention (PCI) and optimized treatment procedure on the incidence and treatment time of the syndrome. Methods The patients undergoing coronary artery intervention in our department from January 1,0 to June 30,8 were enrolled in this study. Among them, 3550 patients received surgical treatment during January 1,0 to June 30,6, and were assigned into conventional group, and 161 [including 108 males, at an age of (57.92±10.42)years] suffered from vasovagal reflex and were given routine treatment. The left 1574 patients who were treated surgically during July 1,6 to June 30,8 were assigned into optimized group, and 13 of them [including 9 males, at an age of (53.01±14.78)years] experienced vasovagal reflex and were treated with optimized treatment procedure. The general information, clinical data, incidence of vasovagal reflex, rescue success rate, rescue time and other clinical data of the patients were collected and compared. SPSS statistics 20.0 was used to perform the statistical analysis. Results There were no statistical differences in age, gender, past medical history and other clinical data between the 2 groups. The incidence of vagal reflex syndrome was significantly lower in the optimized group than the conventional group (0.83% vs 4.54%, P<0.05), and that of severe vagal reflex was more significant (0.13% vs 1.18%, P<0.001). The optimized treatment process obviously shortened the rescue time and improved rescue success rate. What′s more, the optimization also attenuated patients′ anxiety, promoted their satisfaction for the quality of medical care during hospitalization, and shortened the average length of hospital stay [(2.82±1.09) vs (4.56±1.25)d, P<0.05]. Conclusion Our risk prediction model for post-PCI vasovagal reflex syndrome and optimized treatment procedure can reduce the postoperative incidence and shorten the treatment time, and are of certain value in clinical practice.