老年急性冠状动脉综合征患者介入治疗联合替罗非班出血的危险因素评价  

Risk factors for bleeding in elderly patients with acute coronary syndrome undergoing combined PCI and tirofiban treatment

作　　者：贾红丹[1] 国强华[1] 宋婷婷[1] 丛洪良[2] 王庆胜[1] 陈洁[1] 崔蕊[1] 刘丽[1] JIA Hong-dan GUO Qiang-hua SONG Ting-ting et al(Department of Cardiology ,Qinhuangdao No. 1 Hospital,Qinhuangdao 066000, Hebei Province ,China)

机构地区：[1]秦皇岛市第一医院心内科,066000 [2]天津市胸科医院心内科

出　　处：《中华老年心脑血管病杂志》2017年第6期596-599,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的探讨老年急性冠状动脉综合征(acute coronary sundrome,ACS)患者PCI联合替罗非班发生出血并发症的危险因素。方法选择2014年1月~2015年12月在秦皇岛市第一医院心内科住院的ACS患者164例,行PCI时联合应用替罗非班。根据年龄分为老年组71例(年龄≥65岁)和非老年组93例(年龄<65岁),采用TIMI出血标准,分析2组患者出血并发症的发生情况,并应用logistic回归分析老年组发生出血并发症的危险因素。结果老年组术后出血发生率明显高于非老年组(43.1%vs 25.8%,P<0.05)。老年组大出血、小出血发生率明显高于非老年组(14.1%vs 4.3%,P<0.05)。logistic回归分析显示,女性(OR=404.434,95%CI:1.767~92543.210,P=0.030)、体质量(OR=0.817,95%CI:0.675~0.990,P=0.039)、肾小球滤过率(OR=1.185,95%CI:1.003~1.400,P=0.046)是老年组患者术后联合应用替罗非班发生出血风险的独立危险因素。结论老年ACS患者PCI联合替罗非班发生出血并发症的风险高于非老年患者,女性、低体质量、肾功能下降是老年患者术后联合应用替罗非班发生出血风险的预测指标。Objective To study the risk factors for bleeding in elderly patients with acute coronary syndrome （ACS） undergoing combined PCI and tirofiban treatment. Methods One hundred and sixty-four ACS patients undergoing combined PCI and tirofiban treatment in our hospital from January 2014 to December 2015 were divided into ≥65 years old group （n=71） and 〈65 years old group （n=93）. The incidence of bleeding was recorded in two groups according to the TIMI criteria, the risk factors for bleeding in ≥65 years old group were analyzed by logistic regression analysis. Results The incidence of bleeding, massive bleeding and minor bleeding was significantly higher in ≥65 years old group than in ≥65 years old group during combined PCI and tirofiban treatment （43.1% vs 25.8%,P〈0.05;14. 1% vs 4.3%,P〈0.05）. Multivariate logistic regression analysis showed that female,BMI and GFR were the independent risk factors for bleeding in 65 years old group during combined PCI and tirofiban treatment （OR=404. 434,95%CI：1. 767- 92543.210,P=0. 030;OR=0. 817,95%CI：0. 675-0. 990,P=0. 039;OR=1. 185,95%CI： 1. 003-1. 400,P=0. 046）. Conclusion The risk of bleeding is higher in ≥65 years old ACS patients than in ≥65 years old ACS patients. Female,decreased BMI and impaired renal function are the independent risk factors for bleeding in elderly ACS patients during combined PCI and tirofiban treatment.

关 键 词：急性冠状动脉综合征 血小板聚集抑制剂 血小板糖蛋白GPⅡb-Ⅲa复合物 出血 危险因素 

分 类 号：R541.4[医药卫生—心血管疾病]