摘要
目的 研究行经皮冠状动脉介入治疗（PCI）的75岁及以上高龄冠心病患者临床特征并分析术后6个月发生并发症的危险因素。方法 回顾分析2011年1月~2014年2月因冠心病收治入长征医院心内科并接受PCI的患者1228例，其中男性936例，女性292例，年龄30~92岁（60±10岁）。按年龄分为≥75岁组（n=261）和＜75岁组（n=967）。分析比较两组患者入院时基本资料、实验室数据、手术相关治疗数据及围手术期和术后6个月并发症的情况。结果 与＜75岁组比较，≥75岁组患者年龄、住院天数、合并高血压比例、合并慢性肾衰竭比例、合并慢性阻塞性肺疾病比例、既往卒中比例、入院时合并急性心力衰竭比例、入院时合并恶性心律失常比例增加，差异有统计学意义（P均＜0.05）。与＜75岁组比较，≥75岁组患者血红蛋白、血小板、白蛋白、三酰甘油下降，而凝血酶原时间、高密度脂蛋白胆固醇、血肌酐、血尿酸、血尿素氮、pro-BNP升高，RCA和LAD病变比例、三支及以上病变比例、左主干病变比例、钙化病变比例、长病变比例增加，桡动脉入路比例减少，差异有统计学意义（P均＜0.05）。与＜75岁组比较，≥75岁组患者院内死亡、出血相关并发症、造影剂肾病、PCI术中心肌梗死、PCI相关心力衰竭比例增加，术后6个月全因死亡比例增加，非致死性心肌梗死比例减少，差异具有统计学意义（P均＜0.05）。多因素回归分析表明吸烟（OR=3.677，95%CI：1.561~8.622）、入院时合并急性心力衰竭（OR=4.086，95%CI：1.733~9.636）、入院时合并恶性心律失常（OR=9.286，95%CI：3.864~22.316）、既往卒中史（OR=3.517，95%CI：1.524~8.116）与高脂血症（OR=4.996，95%CI：1.278~19.530）是PCI术后并发症的独立危险因素。结论 高龄冠心病患者合并症更多，冠状动脉病变更复杂，PCI术后并发症更多。吸烟、入院时合并急性心力衰竭或恶性心律失常、既往卒中史、高脂血症患者PCI术后发生并发症风险更高。
Objective To study the clinical characteristics in elderly patients (aged 75 or over) with coronaryheart disease (CHD) undergone percutaneous coronary intervention (PCI) and risk factors of complications after 6 m.Methods CHD patients under gone PCI (n=1228, male 936, female 292, aged from 30 to 92 and average age=60±10) were chosen from Jan. 2011 to Feb. 2014, and divided, according to age, into ≥75 group (n=261) and <75 group(n=967). The basic materials, laboratory data, PCI-related data and perioperative complications and complicationsafter 6 m were analyzed and compared in 2 groups. Results The age, hospital days and percentages of patientcomplicating hypertension, chronic renal failure, chronic obstructive pulmonary disease, past stroke, and acuteheart failure and malignant arrhythmia at hospitalization time increased in ≥75 group compared with <75 group(all P<0.05). Compared with <75 group, the levels of hemoglobin, platelet, albumin and triglyceride decreased, andprothrombin time, high-density lipoprotein-cholesterol, serum creatinine, blood uric acid, blood urea nitrogen andNT-proBNP increased, and the percentages of patients with RCA and LAD lesions, 3 or more vessels lesions, left maincoronary artery lesion, calcified lesions and long-term diseases increased, and radial artery approach decreased in ≥75 group (all P<0.05). Compared with <75 group, the percentages of patients with in-hospital mortality, bleedingrelatedcomplications, contrast-induced nephropathy, myocardial infarction during PCI, PCI-related heart failure andall-cause mortality after 6 m increased, and percentage of non-fatal myocardial infarction decreased (all P<0.05).The results of multi-factor regression analysis showed that smoking (OR=3.677,95%CI:1.561~8.622), acuteheart failure at hospitalization time (OR=4.086,95%CI:1.733~9.636), malignant arrhythmia at hospitalizationtime (OR=9.286,95%CI:3.864~22.316), stroke history (OR=3.517,95%CI:1.524~8.116) and hyperlipidemia(OR=4.996,95%CI:1.278~19.530) were independent risk factors of post-PCI complications. Conclusion Thecomplications are common, coronary artery diseases are more complicated and post-PCI complications are more in elderly patients with CHD. At the same time, smoking, acute heart failure or malignant arrhythmia at hospitalizationtime, stroke history and hyperlipidemia are independent risk factors of post-PCI complications.
作者
陈侃
陈鹏飞
王丹宁
黄颖
王磊
廖德宁
CHEN Kan;CHEN Peng-fei;WANG Dan-ning;HUANG Ying;WANG Lei;LIAO De-ning(Department of Cardiology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China)
出处
《中国循证心血管医学杂志》
2016年第4期428-431,435,共5页
Chinese Journal of Evidence-Based Cardiovascular Medicine
基金
上海市科学技术委员会科研计划项目(13411950202)
