医学论文：85岁以上冠心病患者经皮冠脉血运重建术疗效与安全性分析

85岁以上冠心病患者经皮冠脉血运重建术疗效与安全性分

析

[摘要] 目的评估年龄超过85岁的患者接受pci的安全性和有效性，并找出住院和1年生存率的相关危险因素。方法回顾分析2005年1月～2010年12月65例冠状动脉疾病老年患者经皮冠状动脉腔内成形术。对住院和随访1年所采集的临床、血管造影及介入治疗进行了相关变量对数回归分析。结果住院患者的治愈率为90.8%（59/65），住院患者的死亡率为9.2%（6/65）。随访1年发现接受介入治疗的患者1年存活率为83.1%（54/65）。回归分析显示：左心室射血分数是唯一预测住院患者存活率的独立预测因子。随访1年发现，肾功能不全及完全的血管成形术均与临床疗效密切相关。结论本研究表明高龄冠心病患者（年龄大于85岁）进行经皮冠状动脉介入治疗是安全、有效的。它可以有效地缓解症状，并提供住院期间为期1年的后续以及有利的结果。低ef值、不完全心肌血运重建术和肾功能障碍会影响临床疗效。

[关键词] 冠心病；经皮冠状动脉介入；老年人；血运重建

the effect and safety analysis of percutaneous coronary angioplasty in patients aged over 85 with coronary artery disease

mai haiyuan1 tang lijun2

1.department of cardiology, the people′s hospital of heshan city in guangdong province, heshan 529700, china;

2. department of cardiology, the people′s hospital of jiangmen city in guangdong province, jiangmen 529000, china

[abstract] objective to evaluate the safety and efficency of percutaneous coronary intervention (pci) in patients with coronary artery disease (cad) aged over 85 years old and explore the related risk factors of hospitalization and one-year survival rate. methods retrospectively analyzed the clinical data of 65 patients aged over 85 years old with cad and received percutaneous transluminal coronary angioplasty (ptca) from january 2005 to december 2010. logistic regression analysis was used to analyze the related factors of clinical, angiographic and procedure related variables. results the cured rate of inpatients was 90.8% (59/65), the mortality rate of inpatients was 9.2% (6/65). 83.1% (54/65) of the patients receiced pci were still alive when a year later. logistic regression analysis revealed that left ventricular ejection fraction (lvef) was the only independent predictor of the survival rate of inpatients. based on the follow-up visit last a year, we found that complete revascularization and renal dysfunction were closely related with clinical efficacy. conclusion our study indicates that pci is safe and

effective for elder patients aged over 85 years with cad. it can effectively relieve the symptoms and do good to the prognosis even after a year. low ef, incomplete myocardial revascularization and renal dysfunction would hamper clinical efficacy.

[key words] coronary artery disease; percutaneous coronary intervention; elderly; revascularization

冠状动脉疾病老年患者日益增多，其中接受经皮冠状动脉介入治疗（pci）的人数也在增加，但年龄超过85岁患者中接受pci的数据是有限的。与冠状动脉旁路移植术（cabg）或药物治疗相比，pci 在中老年人身上仍然展示了良好的效果[1]。考虑到出血风险，这一年龄段患者一般不采用溶栓治疗，而保守治疗再灌注时间有限，远期效果也不好，这也是患者不愿接受的结果[2]。然而，pci以其机械的心肌血运重建术及微创性优势，可能会成为高龄患者非手术治疗的首选，但其利益和风险的比较争议很大。在这项研究中，笔者的目标是评价本院高龄冠心病患者（年龄大于85岁）进行pci

的安全性、有效，并找出相关影响因素和1年存活率。

1 资料与方法

1.1 一般资料

2005年1月～2010年12月，本院共65例高龄冠心病患者（年龄大于85岁）被纳入本回顾性研究。所有患者均接受了经皮冠状动脉腔内成形术治疗，包括是否有支架植入术或球囊扩张术。冠状