老年急性冠状动脉综合征的急诊介入治疗  

The emergency interventional treatment of acute coronary syndromes in elderly patients

作　　者：吴淳[1] 张玉霄 王伟民[1] 赵红[1] 卢明瑜[1] 刘健[1] 

机构地区：[1]北京大学人民医院,北京100044 [2]解放军第一○六医院,山东济南273300

出　　处：《中华老年心脑血管病杂志》2003年第4期233-236,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的　观察 70岁以上老年人急性冠状动脉综合征 (acutecoronarysyndromes ,ACS)急诊介入治疗的安全性及临床效果。方法　同期行急诊介入治疗的 183例大于 70岁ACS患者 (≥ 70岁组 )与 76例小于 70岁但大于 6 0岁的ACS患者 (对照组 ) ,两组均在心绞痛发作时行冠状动脉造影证实病变 ,根据造影结果选择适宜的介入方式对“罪犯”病变予干预。结果　≥ 70岁组经皮冠状动脉腔内成形术 (PTCA)后置入支架 173枚 ,直接置入支架 2 2枚 ;手术成功率 97.8%;术后 15 1例 (82 .5 %)患者心绞痛消失 ,18例有胸闷感 ,次日自行消失 ,14例患者仍有心绞痛症状 ;对照组PTCA后置入支架 71枚 ,直接置入支架 10枚 ;手术成功率 98.7%;术后 6 5例 (85 .5 %)患者心绞痛消失 ,3例仍有心绞痛症状。两组手术成功率及术后心绞痛改善情况差异无显著性意义 (P >0 .0 5 ) ;置入支架后两组均无急性闭塞和死亡病例 ;随访期内 ,两组心绞痛复发率及复发后接受再次血运重建术情况比较差异无显著性意义 (P >0 .0 5 )。结论　在有条件的心脏介入中心 ,对老年ACS患者行急诊介入治疗是积极有效的 ,与对照组比较 ,手术的成功率、安全性及近、远期临床效果无明显差异。Objective To observe the efficacy and safety of emergency interventional treatment of elderly patients with acute coronary syndromes (ACS).Methods 183 elderly patients aged more than 70 years(elderly group) who underwent coronary stenting were compared with 76 patients aged less than 70 years but more than 60 years(control group) in success rate,clinical efficacy and the follow-up results.They were treated with emergency interventional operation after angiography to demonstrate the features of lesions.All 'culprit' lesions were interfered.Results 173 stents were implanted after PTCA and 22 stents were implanted directly in 183 'culprit' lesions in the elderly group.179 patients had the thrombolysis in myocardial infarction (TIMI) level 3 and 4 patients had TIMI level 2 immediately after the operation (97.8%).151 patients had no symptom of angina after the procedure,and 18 patients had atypical chest pain which disappeared after 24 hours.14 patients still had angina,but had no proof of AMI.71 stents were implanted after PTCA and 10 stents were implanted directly in 76 'culprit' lesions in the control group.75 patients had the TIMI level 3 and 1 patient had TIMI level 2(98.7%).There was no significant difference in technical success rate and clinical efficacy between two groups(P>0.05),and also no fatal case.Conclusion The emergency interventional treatment of elderly patients with ACS,which was done by experienced doctors,was safe and effective in a conditioned interventional treatment center.

关 键 词：冠状动脉硬化 血管成形术 经腔 经皮冠状动脉 急症 支架 

分 类 号：R541.4[医药卫生—心血管疾病]