170例老年冠心病患者临床特点和治疗策略研究  

Research on clinical characteristic and treatment strategy of 170 elderly patients with CHD

作　　者：柳高[1] 楼婷[1] 朱平[1] 司全金[1] 张秀锦[1] 

机构地区：[1]解放军总医院南楼心血管一科,北京100853

出　　处：《中华保健医学杂志》2011年第6期440-443,共4页Chinese Journal of Health Care and Medicine

摘　　要：目的了解老年冠心病患者的基础疾病和危险因素、急性冠状动脉事件类型、治疗措施和预后状况,为老年冠心病的诊断和治疗提供指导。方法选取2003—2008年,因急性冠状动脉综合征在解放军总医院干部病房心内科住院治疗的170例老年冠心病患者,分为保守治疗组与血运重建组,对其一般情况、基础疾病和危险因素、诊断治疗状况和预后进行回顾性分析。结果 (1)老年冠心病患者普遍存在基础疾病和危险因素多、冠状动脉病变复杂的特点。在危险因素中,高血压(84.12%)、2型糖尿病(48.24%)和吸烟(35.88%)占主要比例。(2)需要入院治疗的急性冠状动脉事件中,以非ST段抬高型心肌梗死(NSTEMI)为主,占51.76%;ST段抬高型心肌梗死有相当比重,占31.18%;不稳定型心绞痛相对较少,占17.06%。(3)两组年龄和糖尿病患病率比较,差异有统计学意义(P<0.01);肾功能不全比较,差异有统计学意义(P<0.05),提示这3个因素是限制老年冠心病患者进行血运重建治疗的主要原因。(4)24个月随访观察显示,保守治疗组与血运重建组患者的总体病死率分别为45.69%与37.04%,心源性病死率分别为64.15%与10.00%。结论老年冠心病患者基础疾病和危险因素多、冠状动脉病变复杂。NSTEMI为入院患者急性冠状动脉事件的主要类型。年龄、糖尿病和肾功能不全是限制老年冠心病患者进行血运重建治疗的主要原因。全面、合理、个体化的治疗能够有效延长老年冠心病患者的生存周期,提高生活质量。早期诊断并进行治疗仍然非常关键。Objective To investigate the basic diseases and risk factors,type of acute coronary events,therapeutic methods and prognosis on elderly patients with CHD and make guidance on the diagnosis and treatment of elderly patients with CHD. Methods One hundred and seventy elderly patients with CHD who were hospitalized in Geriatric Cardiology Department because of ACS between 2003-2008 were selected and retrospective analysis was performed on general condition,basic diseases,risk factors,diagnosis,treatment and prognosis. Results （1）In these elderly patients with CHD,multi-basic diseases, multi-risk factors and complex coronary artery lesions were common. Hypertension（84.12%）,type 2 diabetes mellitus（48.24%）and smoking history（35.88%）were the main risk factors. （2）Among these acute coronary events which demanded hospitalization,the main type was NSTEMI（51.76%）,followed STEMI（31.18%）,less UA cases were observed（17.06%）. （3）Compared with the revascularization group,conservative therapy group had a significant statistical disparity on age,type 2 diabetes（P0.01）and renal dysfunction（P0.05）,showed that these 3 factors were the main reason which limited the revascularization therapy in this group CHD patients. （4）Follow up observations found that within two years,the total mortality of the patients in conservative therapy group was 45.69%,and the cardiogenic mortality was 64.15%;The total mortality of the patients in revascularization group was 37.04%,and the cardio-genic mortality was 10.00%. Conclusions Elderly patients with CHD had the characteristic of multi-basic diseases,multi-risk factors and complex coronary artery lesions. NSTEMI still was the main type of acute coronary events in hospitalized cases. Age,type 2 diabetes and renal dysfunction were the main reasons which limited the revascularization therapy in these patients. Reasonable and individual treatment could efficiently prolong the life span and improve the living quality of elderly patients with CHD. Early diagn

关 键 词：老年 冠心病 急性冠状动脉事件 临床特点 治疗策略 

分 类 号：R541.4[医药卫生—心血管疾病]