摘要
目的：探讨老年冠心病（CHD）患者经皮冠状动脉介入（PCI）围术期药物治疗的特点。方法回顾性分析2008年7月至2012年11月在沈阳军区总医院接受PCI治疗的13049例CHD患者的临床资料，比较非老年人（＜60岁，n＝5810）、低龄老年人（60～74岁，n＝5640）及高龄老年人（≥75岁，n＝1599）在PCI围术期药物治疗上的差异。结果随年龄增长，患者合并高血压、心律失常、肾功能不全、卒中等基础疾病的比例显著增高。溶栓治疗的比例随年龄增长呈明显阶梯型下降趋势（17.5%vs 14.3%vs 7.2%；P＜0.001）。围术期应用血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂随年龄增长显著降低（32.4% vs 27.2% vs 11.0%；P＜0.001）。低龄老年组和非老年组围术期应用负荷剂量阿司匹林（99.3%vs 98.4%）和氯吡格雷（93.7%vs 93.8%）、高维持剂量阿司匹林（55.4%vs 55.9%）的比例无明显差异（均P＞0.05），但均显著高于高龄老年组（88.7%，P＜0.001；91.5%，P＝0.006；47.6%，P＜0.001）。3组患者围术期应用肝素的比例无显著差异，但老年患者应用磺达肝癸钠的比例高于非老年患者（35.9% vs 38.0% vs 38.7%；P＝0.026）。老年患者接受心血管基础药物治疗（包括血管紧张素受体Ⅱ抑制剂、钙离子通道阻滞剂、利尿剂、洋地黄、硝普钠等）的比例显著高于非老年患者。结论老年CHD患者PCI围术期应用溶栓及抗栓治疗的比例显著低于非老年患者，而其他心血管基础药物治疗的比例则显著增高。
Objective To determine the characteristics of peri-operative medications in the elderly patients with coronary heart diseases （CHD） undergoing percutaneous coronary intervention （PCI）. Methods Clinical data of 13 049 patients with CHD undergoing PCI in Shenyang General Hospital of Shenyang Military Command from July 2008 to November 2012 were collected and retrospectively analyzed. The cohort of patients were divided into non-aged （〈60 years old, n=5810）, younger aged （≤60 to 〈74 years old, n=5640） and senior aged （≥75 years old, n=1 599） groups according to their age. Their characteristics of peri-operative medications were analyzed and compared among the 3 groups. Results With the increase in age, the proportions of comorbidities such as hypertension, cardiac arrhythmia, renal insufficiency and prior stroke were significantly elevated. There were less patients receiving thrombolytic therapy with the increase in their age （17.5% vs 14.3% vs 7.2%, P〈0.001）. The percentage of using platelet glucose protein Ⅱb/Ⅲa receptor inhibitors was significantly decreased with the increased age （32.4% vs 27.2% vs 11.0%, P〈0.001）. There was no significant difference between the younger aged and non-aged patients in using of loading dose of aspirin, clopidogrel and high maintenance dose of aspirin （99.3%vs 98.4%, 93.7% vs 93.8%, 55.4% vs 55.9%, all P〉0.05）, but percentages of the 2 groups were significantly higher than the senior aged group （88.7%, P〈0.001; 91.5%, P=0.006; 47.6%, P〈0.001）. No obvious difference was seen in the peri-operative dose of heparin therapy among the 3 groups. More patients from younger and senior aged groups received fondaparinux sodium therapy than the non-aged one （35.9%vs 38.0%vs 38.7%, P=0.026）. The uses of foundational cardiovascular medications （including angiotensin Ⅱ receptor antagonists,calcium channel blockes, diuretics, digitalis and sodium nitroprusside） were more common in the aged patients than in non-aged group. Conclusio
出处
《中华老年多器官疾病杂志》
2014年第6期416-421,共6页
Chinese Journal of Multiple Organ Diseases in the Elderly
基金
国家“十二五”科技支撑计划课题（2011BAI11B07）
关键词
冠心病
经皮冠状动脉介入
老年人
药物治疗
coronary heart disease
percutaneous coronary intervention
aged
medications
