80岁及以上老年冠心病患者增强型体外反搏的疗效和安全性

Investigation of the efficacy and safety of enhanced external counter pulsation in treatment of coronary heart disease in patients aged 80 years and older

目的探讨增强型体外反搏(EECP)治疗对80岁及以上冠心病患者的疗效及安全性。方法采用前瞻性研究,连续入选2016年5月至2017年10月在我院接受治疗的老年冠心病患者336例,根据年龄和治疗方法分为高龄EECP组84例,高龄对照组84例,老年EECP组168例。高龄对照组给予抗血小板药物、血管紧张素转化酶抑制剂、血管紧张素Ⅱ受体拮抗剂、β受体阻滞剂、钙拮抗剂、硝酸酯类、他汀类等常规治疗,高龄和老年EECP组患者在高龄对照组治疗基础上增加1个疗程EECP治疗(0.5h/次,2次/d,36d/疗程)。观察1个疗程后高龄对照组和高龄EECP组、老年EECP组患者的疗效[西雅图心绞痛量表(SAQ)、匹兹堡睡眠质量指数量表(PSQI)]变化及主要不良心血管事件发生率、再住院率。结果1个疗程后,高龄EECP组和老年对照组躯体活动受限程度(35.7±10.7)分比(26.0±12.1)分、心绞痛稳定程度(53.3±22.9)分比(33.9±18.9)分、心绞痛发作频率分值(39.6±16.5)分比(30.4±21.1)分、治疗满意度分值(38.0±6.0)分比(33.7±4.7)分;睡眠质量分值(1.0±0.7)分比(2.8±0.7)分、入睡时间分值(1.3±0.6)分比(2.4±0.5)分、睡眠时间分值(0.9±0.6)分比(2.3±0.6)分、睡眠效率分值(1.1±0.6)分比(2.5±0.6)分、睡眠障碍分值(1.2±0.4)分比(2.2±0.6)分、催眠药物分值(1.2±0.6)分比(2.2±0.6)分、日间功能障碍分值(1.3±0.5)分比(2.3±0.6)分(均P<0.01)。高龄EECP组主要心血管事件发生率为31.0%(26/84),低于对照组66.7%(56/84)(P<0.05)。高龄EECP组和老年EECP组1个月、3个月、6个月、12个月再住院率、主要心血管事件发生率比较差异无统计学意义(P>0.05)。结论高龄老年冠心病患者行EECP治疗相对安全、有效。

ObjectiveTo investigate the efficacy and safety of enhanced external counter pulsation(EECP)in treatment of coronary heart disease in patients aged 80 years and older. MethodsThe 336 consecutive elderly patients with coronary heart disease were treated in our hospital from May 2016 to October 2017 in a prospective study.The 168 coronary heart disease patients aged 80 years and older were divide into a control group(n=84)receiving conventional therapy(anti-platelet drugs, angiotensin converting enzyme inhibitors, angiotensin-receptor blocker, β-blockers, calcium antagonists, nitrates, statins), and EECP group(n=84)receiving enhanced external counter pulsation 0.5 h/time, 2 times per day, 36 days as a course as add-on therapy to conventional therapy.And 168 patients aged 60~79 years received the same therapy as those in EECP group.After one course of EECP treatment, the therapeutic effects were evaluated by Seattle angina questionnaire(SAQ)and Pittsburgh sleep quality index(PSQI), and the incidence of major adverse cardiovascular events and readmission rate were compared between groups of the EECP vs.control group and group of patients aged 60-79 years. ResultsThe scores of SAQ and PSQI were better in the EECP group than in the control group after one course of EECP treatment, as follows: physical limitation(35.7±10.7 vs.26.0±12.1), anginal stability(53.3±22.9 vs.33.9±18.9), anginal frequency(39.6± 6.5 vs.30.4±21.1), treatment satisfaction(38.0±6.0 vs.33.7±4.7), subjective sleep quality(1.0±0.7 vs.2.5±0.7), sleep latency(1.3±0.6 vs.2.4±0.5), sleep duration(0.9±0.6 vs.2.3±0.6), habitual sleep efficiency(1.1±0.6 vs.2.5±0.6), sleep disturbances(1.2±0.4 vs.2.2±0.6), use of sleeping medication(1.2±0.6 vs.2.2±0.6), and daytime dysfunction score was 1.3±0.5 vs.2.3±0.6(P<0.01). The incidence of major adverse cardiovascular events was lower in the EECP group(31.0%, 26/84)than in the control group(66.7%, 56/84)(P<0.05). At 1, 3, 6, 12 months after EECP treatment, there was no significant difference in the incidence of major adverse cardiovascular events and readmission rate between patients aged 60-79 years vs.80 years and over(P> 0.05). ConclusionsEECP treatment is relatively safe and effective for coronary heart disease patients aged 80 years and older.