高龄急性心肌梗死患者急诊介入的有效性和安全性分析  

Analysis of the efficacy and safety of emergency intervention therapy in senile patients with acute myocardial infarction

作　　者：关韶峰 陈阳[1] 李天奇[1] 张亮[1] 刘鸿元[1] 洪慰麟[1] 常锡峰[1] 干倩 郭新贵[1] 方唯一 曲新凯 韩文正 Guan Shaofeng;Chen Yang;Li Tianqi;Zhang Liang;Liu Hongyuan;Hong Weilin;Chang Xifeng;Gan Qian;Guo Xingui;Fang Weiyi;Qu Xinkai;Han Wenzheng(Cardiovascular Department,Huadong Hospital Affiliated to Fudan University,Shanghai,200040,P.R.China)

机构地区：[1]复旦大学附属华东医院心血管科,上海200040

出　　处：《老年医学与保健》2020年第4期622-624,632,共4页Geriatrics & Health Care

基　　金：上海市卫生和计划生育委员会科技发展基金项目(201840278)。

摘　　要：目的分析高龄急性ST段抬高心肌梗死(STEMI)患者的临床特征和急诊经皮冠状动脉介入术(PCI)治疗的有效性及安全性。方法回顾性分析近10年住院诊治的行急诊PCI治疗的高龄STEMI患者86例(≥80岁),并和同期非高龄老年组(65~79岁)110例患者进行对比。比较2组基线临床特征、造影特征和临床治疗结果的差异。结果2组患者性别、高血压、糖尿病、高脂血症、吸烟史、冠心病家族史差异无统计学意义(P>0.05),但高龄组肾功能不全(51.2%vs 34.5%,P=0.019)和中度以上贫血的比例(19.8%vs 9.1%,P=0.031)更高。2组患者"罪犯"血管分布差异无统计学意义(P>0.05),但高龄组有着更多的多支病变比例(46.5%vs 29.1%,P=0.012),2组患者经桡动脉入路比例、最终TIMI血流、门-球时间亦无差异(P>0.05),高龄组术后左心室射血分数(LVEF)低于非高龄组[(51.9±9.1)%vs(53.0±6.6)%,P=0.004],发生心力衰竭比例高于非高龄组(29.1%vs 14.5%,P=0.013),但2组住院期间主要不良事件(死亡和发生心源性休克、心律失常和急性肾功能不全)发生率和30 d死亡率差异无统计学意义(P>0.05)。结论急诊PCI治疗80岁以上高龄STEMI患者安全有效。Objective To analyze the clinical characteristics of senile patients with acute ST segment elevation myocardial infarction(STEMI)and the efficacy and safety of emergency percutaneous coronary intervention(PCI).Methods 86 senile STEMI patients(≥80 years old)who were hospitalized for emergency PCI in last 10 years were analyzed retrospectively,and compared with 110 patients of non-senile patients(65-79 years old)in the same period.The baseline clinical features,angiographic features and clinical treatment results were compared between the two groups.Results There was no significant difference in gender,hypertension,diabetes,hyperlipidemia,smoking history and family history of coronary heart disease between the two groups(P>0.05),but the rate of renal insufficiency(51.2%vs 34.5%,P=0.019)and moderate or higher anemia(19.8%vs 9.1%,P=0.031)in the senile group was higher.There was no statistically significant difference in the distribution of"criminal"blood vessels between the two groups(P>0.05),but the senile group had more multivessel disease(46.5%vs 29.1%,P=0.012).There was no difference in the ratio of the transradial approach,the final TIMI blood flow,and the door to balloon time between the two groups(P>0.05).The postoperative left ventricular ejection fraction(LVEF)of the senile group was lower than that of the non-senile group[(51.9±9.1)%vs(53.0±6.6)%,P=0.004],and the rate of heart failure was higher than that of the non-senile group(29.1%vs 14.5%,P=0.013),but therewas no significant difference in the incidence ofmajor adverse events(death and cardiogenic shock,arrhythmia and acute renal insufficiency)and 30 day mortality between the two groups(P>0.05).Conclusion Emergency PCI is safe and effective in treating STEMI patients over 80 years old.

关 键 词：高龄 心肌梗死 ST段抬高 急诊介入 

分 类 号：R542.22[医药卫生—心血管疾病]