老年冠心病患者药物治疗与经皮冠状动脉介入术+药物治疗的比较  

Comparison of Combination Therapy of Drugs and PCI with Drugs Alone for Coronary Heart Disease in Aged Patients

作　　者：汪鸿彬[1] 梅志亮[1] 王晓华[1] 吴小和[1] 

机构地区：[1]江西省人民医院心血管内科,南昌330006

出　　处：《实用临床医学（江西）》2012年第11期1-3,13,共4页Practical Clinical Medicine

基　　金：江西省卫生厅科技计划项目(20093005)

摘　　要：目的观察老年冠心病患者采用单纯强化药物治疗及经皮冠状动脉介入术(PCI)+强化药物治疗的近期及远期疗效。方法将160例年龄≥65岁、经冠状动脉造影检查为单支或多支血管病变的老年冠心病患者,按随机数字表法分为2组,单纯强化药物治疗组82例,给予拜阿司匹林100 mg.d-1抗血小板聚集治疗;PCI+强化药物治疗组78例,在行PCI成功植入支架后,给予拜阿司匹林100 mg.d-1、氯吡格雷75 mg.d-1抗血小板聚集治疗。2组疗程为2年。记录2组患者住院治疗期间和2年随访期间心绞痛症状缓解、急性冠脉综合征(ACS)及心源性死亡等事件发生情况。结果 PCI+强化药物治疗组院内治疗期间心绞痛症状缓解率高于单纯强化药物治疗组(P<0.05);2组急性心肌梗死及心源性病死率比较差异均无统计学意义(均P>0.05)。2组均获24～28(22.5±3.2)个月的随访,PCI+强化药物治疗组心绞痛症状缓解率仍高于单纯强化药物治疗组(P<0.05),2组患者心源性死亡、急性心肌梗死的发生率比较差异均无统计学意义(均P>0.05)。结论 PCI+强化药物治疗,住院期间及术后2年心绞痛缓解率均高于单纯强化药物治疗,但2组患者2年后的临床预后类似。Objective To observe the short-term and long-term effects of intensive drug therapy alone or in combination with percutaneous coronary intervention（PCI） on coronary heart disease in elderly patients.Methods A total of 160 coronary heart disease patients 65 years old or older who were diagnosed as single or multiple vascular lesions by coronary angiography examination were randomly divided into two groups.Intensive drug treatment group（n=82） was given anti-platelet therapy with 100 mg·d-1 aspirin for two years.Combined treatment group（n=78）was given anti-platelet therapy with 100 mg·d-1 aspirin and 75 mg·d-1 clopidogrel after PCI for stent placement.The course of treatment was 2 years.The remission rates of angina and incidences of acute coronary syndrome and cardiac death were recorded.Results During hospitalization and after an average of 22.5 months of follow-up（range 24 to 28 months）,the remission rates of angina in combined treatment group were significantly higher than that in intensive drug treatment group（P0.05）,but there were no obvious differences in the incidences of acute myocardial infarction and cardiac death between the two groups（P0.05）.Conclusion Compared with intensive drug therapy alone,combined treatment with drugs and PCI can significantly increase the remission rates of angina pectoris in patients with coronary heart disease.However,the two methods lead to the similar clinical outcomes after treatment for 2 years.

关 键 词：冠心病 心绞痛 拜阿司匹林 氯吡格雷 经皮冠状动脉介入术 预后 

分 类 号：R541.4[医药卫生—心血管疾病]