老年冠状动脉粥样硬化性心脏病合并慢性肾功能不全介入治疗安全性及疗效分析  

Study on safety and therapeutic effect of percutaneous coronary intervention in elderly patients with coronary artery disease and chronic renal insufficiency

作　　者：李怡[1] 吕豪[1] 张英[1] 

机构地区：[1]武警北京总队第二医院心肾内科,北京100037

出　　处：《中国现代医学杂志》2013年第20期89-93,共5页China Journal of Modern Medicine

摘　　要：目的探讨老年冠状动脉粥样硬化性心脏病(冠心病)合并慢性肾功能不全(CRI)患者行经皮冠状动脉介入治疗(PCI)的安全性、临床特征及预后。方法对50例CRI及50例肾功能正常的老年冠心病患者的基本临床特征、介入手术情况和肾功能变化等资料进行统计学分析。结果①两组患者年龄、性别构成、高血压、糖尿病等情况差异无统计学意义(P>0.05),两组具有可比性;②MRI组造影剂肾病(CIN)发生率较对照组明显增加(P<0.05),但1个月后血肌酐及肾小球率过滤均恢复术前水平,术后6个月复查较术前无明显升高(P>0.05);③MRI组患者冠状动脉病变以3支病变为多,对照组冠状动脉病变以2支病变为多。MRI组介入治疗实施困难,以接受优化药物治疗为主;④随访6个月,MRI组心血管不良发生率明显高于对照组。结论老年冠心病合并CRI患者经围术期调整治疗方案可耐受PCI治疗,安全性较高。如冠状动脉病变较重,再血管化困难,预后较差。【Objective】 To investigate the safety,clinical characteristics and prognosis of percutaneous coronary intervention（PCI） in elderly patients with coronary artery disease（CAD） and chronic renal insufficiency（CRI）.【Methods】 The retrospective analysis was performed in 50 elderly patients with CAD and CRI（MRI group）,50 elderly patients only with CAD（control group）,and all patients underwent PCI.The data of basic clinical characteristics,intervention and renal function in both of the two groups were recorded and analyzed statistically.【Results】 The clinical characteristics were all similar（P 0.05）,such as age,sex construction,the incidence of hypertension,diabetes etc.There was comparability between the two groups.Compared with control group,the incidence of contrast induced nephropathy（CIN） was higher（P 0.05） in MIR group.But all of the patient＇s serum creatinine（Scr） and glomerular filtration rate（GFR） recovered to the levels before PCI after 1 month.And the levels were all similar after 6 months（P 0.05）.There were more cases with triple vessel lesions in MRI group,and more cases with double vessel lesions in control group.And fewer cases received percutaneous coronary intervention;more cases received medication in MRI group than in control group.The incidence of major adverse cardiac events during 6 months was higher in MRI group than in control group.【Conclusion】 If proper methods of treatment are used during perioperative period,PCI in the elderly patients with CAD and CRI is safe and effective.But the coronary artery lesions are higher,the inci-dence of revascularization is lower,and the prognosis is not very good.

关 键 词：慢性肾功能不全 冠状动脉粥样硬化性心脏病 老年患者 经皮冠状动脉介入治疗 造影剂肾病 

分 类 号：R541.4[医药卫生—心血管疾病]