重庆地区老年冠心病患者治疗方案与中远期再入院率的相关性  

Correlation of treatment regimen with middle- and long-term rehospitalization in senile patients with coronary heart diseases in Chongqing region of China

作　　者：王笑梅[1] 肖航[1] 唐刚[1] 司良毅[1] 

机构地区：[1]第三军医大学附属西南医院老年病科,重庆400038

出　　处：《中华老年多器官疾病杂志》2013年第6期417-421,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

摘　　要：目的 探讨70岁以上经冠状动脉造影明确为冠心病的患者其治疗方式的选择与患者出院后1年、3年再入院率的关系。方法 对2008年1月至2011年10月住院的70岁以上老年冠心病患者的临床资料和电话随访记录进行回顾性分析。按血管病变及手术处置方式的不同将符合纳入标准的211例患者分为4组。A组（n＝38）：冠状动脉狭窄＞70%，由于各种原因拒绝植入冠状动脉支架的患者；B组（n＝40）：接受冠状动脉支架植入术，术后有部分血管狭窄＞50%的患者；C组（n＝106）：接受冠状动脉支架植入术，术后无＞50%的血管狭窄的患者；D组（n＝27）：冠状动脉造影提示血管狭窄在50%～70%，未接受冠状动脉支架植入术的患者。各组中2008年1月至2009年10月住院的患者分别纳入A1（n＝24），B1（n＝18），C1（n＝50），D1（n＝16）亚组。根据电话随访资料，统计A，B，C，D组（A1，B1，C1，D1亚组）患者出院1年内因心血管疾病住院治疗的例数，A1，B1，C1，D1亚组患者出院1年及3年内因心血管疾病住院治疗的例数。结果 A，B，C，D组及A1，B1，C1，D1亚组患者基线年龄、性别、合并糖尿病、高血压病、吸烟史，以及血肌酐、胆固醇、血红蛋白、B型利钠肽水平差异无统计学意义（P＞0.05）。A，B，C，D组及A1，B1，C1，D1亚组患者1年内再次入院率分别为28.9%（29.2%），20.0%（22.2%），6.6%（6.0%）和7.4%（6.3%），A组再入院率与总体入院率（13.3%）差异有统计学意义（P＝0.026）；A1，B1，C1，D1亚组患者3年内再入院率分别为41.6%，27.8%，10.0%和25.0%，A1和C1组与总体再入院率（22.2%）差异有统计学意义（P＝0.047，P＝0.048）。多元回归分析提示糖尿病和治疗方案是患者是否再入院的危险因素（均P＜0.01）。结论 在冠状动脉造影提示有＞70%的血管狭窄的70岁以上的老年患者中，接受支架植入手术的�Objective To investigate the correlation of different options of treatment regimens with 1- and 3-year rehospitalization rate in the patients aged over 70 years with coronary heart diseases （CHD） diagnosed by coronary angiography. Methods A retrospective cohort study was carried out on the clinical data and follow-up phone calls in the inpatients over 70 years old hospitalized in our department from January 2008 to October 2011. The 211 enrolled patients were divided into four groups according to their vasculopathy and surgical approach. In group A（n=38）, the patients refused interventional therapy, with ≥70% stenosis in coronary artery. In group B（n=40）, the patients received percutaneous coronary angioplasty and stent implantation, with ≥50% stenosis in coronary artery. In group C（n=106）, the patients received percutaneous coronary angioplasty and stent implantation, without ≥50% stenosis in coronary artery. In group D（n=27）, the patients had no necessity for percutaneous coronary intervention though with 50% to 70% stenosis in coronary artery. In these four groups, patients hospitalized during January 2008 to October 2009 were subjected into four subgroups respectively, as group A1（n=24）, B1（n=18）, C1（n=50） and D1（n=16）. Numbers of patients who rehospitalized due to heart event in the followed 1 or 3 years were noted and compared. Results There were 211 （108） patients enrolled into the four groups （subgroups）. There was no significant difference in their age, gender, complicated with diabetes and hypertension, smoking, and serum levels of creatinine, cholesterol, hemoglobin and B-type natriuretic peptide （BNP） between the four groups （subgroups） at baseline （P〉0.05）. The rehospitalization rate in followed one year was 28.9% （29.2%）, 20.0% （22.2%）, 6.6% （6.0%） and 7.4% （6.3%） respectively for the four groups （subgroups） respectively, with that of group A statistically different to total rate （13.3%, P=0.026）. The rehospitali

关 键 词：冠状动脉粥样硬化性心脏病 老年人 冠状动脉支架植入术 再入院率 

分 类 号：R592[医药卫生—老年医学] R541.4[医药卫生—内科学]