老老年冠心病患者临床特点及治疗分析

Clinical analysis on characteristics and treatment in very old patients with coronary heart disease

目的研究老老年(≥80岁)冠心病(CHD)患者的冠状动脉病变及介入治疗特点,为老老年患者的治疗提供临床依据。方法选取2013年1月至2015年12月我院收治行冠状动脉造影的48例老老年(≥80岁,老老年组)和260例老年(65~79岁,老年组)CHD患者,对其危险因素、累及血管、Gensini评分及围手术期并发症发生率进行分析。计量资料用均数±标准差(±s表示,两组比较采用t检验。计数资料用百分率表示,组间比较用χ~2检验。结果老老年组男性急性心肌梗死、陈旧性心肌梗死、高血压、糖尿病、高胆固醇血症和脑梗死发生率显著高于老年组(P<0.05)。老老年组患者以多支病变为主,左主干病变与慢性闭塞病变发生率显著高于老年组(P<0.05);老老年组Gensini评分显著高于老年组(P<0.05)。围手术期和术中并发症两组无显著差异,但老老年组围手术期死亡率较老年组有增加的趋势。结论老老年CHD患者临床危险因素和基础疾病多,冠状动脉病变复杂,狭窄程度严重。应综合评估患者的手术获益与风险,实施更安全有效的治疗方案。

Objective To investigate the characteristics of coronary lesions in the patients older than 80 years with coronary heart disease （CHD） in order to provide the clinical basis for the treatment of CHD.Methods A total of 48 senior patients （over 80 years old,the very aged group） and 260 old patients （65 to 79 years old,the aged group） with coronary heart disease admitted to our department from January 2013 to December 2015 were enrolled in this study.The risk factors,distribution of coronary lesions segments,Gensini scores of coronary lesions,and incidences of complications were compared between the 2 groups.The measurement data were expressed as mean±standard deviation （x^-±s）,and Student＇s t test was employed for the comparison between groups.Enumeration data were expressed as percentage,and inter-group comparison was carried out with Chi-square test.Results The incidence rates of acute myocardial infarction,old myocardial infarction,high blood pressure,diabetes,hypercholesteremia,and cerebral infarction were significantly higher in the males from the very aged group than the aged group（P〈0.05）.Most patients of the very aged group suffered from muti-vessel lesions,and had high incidences of left main coronary artery and chronic occlusion lesion,and higher Gensini score than the aged group（P〈0.05）.There were no significant differences in the occurrences of peri-operative and intra-operative complications between the 2 groups,but the very aged patients presented an increasing trend in peri-operative mortality rate.Conclusion The very aged patients with CHD have more clinical risk factors and underlying diseases than the aged ones,with complicated coronary lesions and more serious coronary artery stenosis.Comprehensive assessment should be carried out for the benefit and risk of surgery in the very aged patients with CHD in order to implement a safer and more effective treatment plan.