本文選題：冠心病 + 老年��； 參考：《昆明醫(yī)科大學》2017年碩士論文

【摘要】：[目的]通過觀察老年冠心病患者的臨床資料,分析其特點及各危險因素之間的關系,并隨訪老年患者經(jīng)皮冠狀動脈介入治療(Percutaneous coronary intervention,PCI)后的短中期主要心腦血管不良事件(Major adverse cardiovascular and cerebrovascular events,MACCE)的發(fā)生情況,通過分析其PCI術后2年內的預后,預測老年人PCI治療后發(fā)生MACCE的危險因素,以提高臨床醫(yī)生對老年冠心病患者PCI治療的認識,為老年人冠心病患者PCI治療的安全性及有效性提供參考。[方法]1、資料收集,搜集整理2015年1月1日—2016年1月1日期間,昆明醫(yī)科大學第一附屬醫(yī)院出院病案室患者。納入標準:a、經(jīng)冠狀動脈造影(Coronary Angiography,CA)確診為冠心病,b、年齡≥65歲,c、所有患者均為首次行PCI治療,d、每例患者均至少置入一枚藥物洗脫支架。排除標準:a、其他系統(tǒng)的嚴重疾病,如惡性腫瘤、先天性心臟病、慢性呼吸系統(tǒng)疾病、嚴重肝腎功能不全、精神病等。P0.05為差異有統(tǒng)計學意義。資料包括:一般資料、臨床資料、隨訪資料。所得資料均為患者PCI術前資料,通過病歷獲得。2、隨訪,通過門診、出院病案室、電話隨訪三種方式獲得,隨訪時間15個月～24個月,隨訪內容包括藥物服用情況、再發(fā)心絞痛、心肌梗死、再次血運重建、再次因心臟事件入院、腦卒中、惡性心臟事件、全因死亡等。3、采用SPSS18.0軟件進行統(tǒng)計分析,計數(shù)資料采用頻數(shù)(百分比)描述,組間比較采用t檢驗、方差分析或χ2檢驗,多因素分析采用logsitic回歸,P0.05表示差異有統(tǒng)計學意義。[結果]1、資料分析1.1 一般資料納入310例患者,最大年齡86歲,最小年齡65歲,平均年齡(71.01 ±4.77)歲,65～69 歲患者(140)45.2%,70～74 歲患者(92)29.7%,75～79 歲患者(60)19.4%,≥80歲患者(18)5.8%;男性(211)68.1%,女性(99)31.9%;共置入支架562枚,全部為藥物洗脫支架。1.2年齡分組將年齡分為四組發(fā)現(xiàn)年齡≥65歲的老年冠心病患者,合并高血壓最為常見(50%),在75～79歲組甚至達到75.0%;糖尿病、高尿酸血癥、血脂紊亂在年齡≥65歲的冠心病患者中發(fā)生率分別為28.7%、25.2%、28.4%,但四種疾病在各年齡分組中差異無統(tǒng)計學差異;年齡≥65歲的患者以心肌梗死入院比例為58.4%,年齡組差異有統(tǒng)計學意義;冠狀動脈3支病變占總人數(shù)48.4%,發(fā)生率近單支病變和雙支病變的總和,但各年齡分組中差異無統(tǒng)計學意義;左室射血分數(shù)50%的發(fā)生率與年齡成正相關關系,但各年齡組差異無統(tǒng)計學意義。1.3 Gensini評分分組隨著Gensini評分分組越高,年齡呈1-3歲遞增,分數(shù)隨著年齡的增大而增高,各評分分組中差異有統(tǒng)計學意義;糖尿病的患病率隨著Gensini評分增高而增高,比率依次為16.9%、23.6%、29.2%、30.3%,各評分組差異有統(tǒng)計學意義;血脂紊亂的患病率隨著Gensini評分增高依次為21.6%、25.0%、25.0%、28.4%,但各評分組差異無統(tǒng)計學意義;Gensini評分與置入支架數(shù)量和冠脈病變支數(shù)呈正相關,在各積分組差異有統(tǒng)計學意義;Gensini評分與心肌梗死入院呈正相關,在各積分組差異有統(tǒng)計學意義。2、隨訪情況2.1藥物服用情況雙抗藥物服用1年患者占9.1%、MACCE發(fā)生率為89.47%,差異有統(tǒng)計學意義;未遵醫(yī)囑服用控制血脂藥物患者占36.80%,MACCE發(fā)生率為61.06%,差異有統(tǒng)計學意義;未遵醫(yī)囑服用控制尿酸藥物的患者43.00%,MACCE發(fā)生率為88.24%,差異有統(tǒng)計學意義;未遵醫(yī)囑服用控制血壓藥物的患者占35.50%,MACCE發(fā)生率為36.70%,差異無統(tǒng)計學意義;未遵醫(yī)囑服用控制血糖的患者占4.49%,MACCE的發(fā)生率為100.00%,差異無統(tǒng)計學意義。2.2 MACCE發(fā)生情況隨訪結果進行單因素分析得出年齡、高血壓、糖尿病、血脂紊亂、高尿酸血癥、未規(guī)律服用藥物(雙抗藥物、控制血脂藥物、控制血尿酸藥物)、左室射血分數(shù)50%、心功能分級高、BNP≥400pg/L、高敏C反應蛋白增高患者在術后1～2年內發(fā)生MACCE分別與無以上危險因素的患者人群相比,有明顯相關性,差異均有統(tǒng)計學意義,χ2值依次為 23.951、6.140、4.527、4.708、13.809、(62.878、64.248、41.086)、4.954、7.913、8.792、9.327,P 值0.05。年齡、高尿酸血癥、左室射血分數(shù)50%、高血脂、糖尿病是年齡≥65歲的冠心病患者PCI術后2年內發(fā)生MACCE的危險因素,OR值依次為1.117、3.206、1.944、3.874、2.461,P值0.05。[結論]1、老年冠心病患者基礎疾病多,多合并高血壓、糖尿病、高尿酸血癥、血脂紊亂等疾病;冠狀動脈病變嚴重,3支及多支病變比例高;以心肌梗死入院多見,病情危重,臨床上應加強老年冠心病的預防及篩查,及時發(fā)現(xiàn)并治療老年冠心病。2、Gensini評分可以較好的評估冠脈病變嚴重程度,年齡、糖尿病、血脂紊亂與Gensini評分呈正相關,說明3者對冠脈病變嚴重程度有促進作用,冠脈病變程度越嚴重,以心肌梗死入院的可能性越大。3、老年冠心病患者服用雙聯(lián)抗血小板藥物及降血糖藥物遵醫(yī)囑率高,降壓藥及降脂藥次之,高尿酸血癥藥物遵醫(yī)囑率較差;雙抗藥物1年、未規(guī)律服藥與2年內發(fā)生MACCE相關,其中雙抗藥物1年及未規(guī)律服用降脂藥物關系最為密切,臨床上應重視患者PCI后服藥的依從性。4、年齡、高血壓、血脂紊亂、糖尿病、高尿酸血癥、心功能不全可能是老年冠心病患者PCI術后2年內發(fā)生MACCE的危險因素。
[Abstract]:[Objective] to observe the clinical data of the elderly patients with coronary heart disease, analyze the characteristics and the relationship between the risk factors, and follow up the short medium and medium-term major cardiovascular adverse events (Major adverse cardiovascular and cerebrovascular events, after percutaneous coronary intervention (Percutaneous coronary intervention), PCI). MACCE), through the analysis of the prognosis within 2 years after PCI, the risk factors of MACCE after PCI treatment in the elderly were predicted to improve the understanding of PCI treatment for the elderly patients with coronary heart disease, and to provide reference for the safety and effectiveness of PCI treatment for the elderly patients with coronary heart disease. [method]1, data collection, collection and collation in 2015 1 During the period from 1 to January 1, 2016, patients from the First Affiliated Hospital of Kunming Medical University were discharged from the hospital. The standard: A, Coronary Angiography (CA) was diagnosed as coronary heart disease, B, age 65 years old, C, all patients were treated for the first time PCI treatment, D, at least one drug eluting stent was placed in each case. Exclusion criteria: A, it The serious diseases of his system, such as malignant tumor, congenital heart disease, chronic respiratory system disease, severe liver and kidney dysfunction, and psychosis,.P0.05 were statistically significant differences. The data included general data, clinical data and follow-up data. All the data were data of preoperative PCI,.2, follow-up, outpatient and discharge disease. The follow-up period was 15 months to 24 months, followed up with three methods, including drug use, angina, myocardial infarction, revascularization, heart events, stroke, malignant heart events, all causes of death,.3, SPSS18.0 software for statistical analysis, counting data using frequency (100%). T test, variance analysis or chi 2 test, multiple factor analysis using Logsitic regression, P0.05 indicated that the difference was statistically significant. [results]1, data analysis 1.1 general data were included in 310 patients, the maximum age was 86 years, the minimum age 65 years, the average age (71.01 + 4.77) years, 65~69 years old (140) 45.2%, 70~74 years old Patients (92) 29.7%, 75~79 years old (60) 19.4%, 80 years old (18) 5.8%; male (211) 68.1%, female (99) 31.9%; total stent 562, all for the drug eluting stent.1.2 age group to divide age group to age older patients with coronary heart disease, combined hypertension most common. The incidence of diabetes, hyperuricemia and dyslipidemia were 28.7%, 25.2%, 28.4% in patients aged 65 years old, but there was no statistical difference between the four diseases in age groups. The rate of admission to patients with myocardial infarction was 58.4%, the age group was statistically significant, and 3 of the coronary arteries accounted for the total number of patients with the age of 65 years old. The total number was 48.4%, the incidence was close to the single and double branch lesions, but there was no significant difference in age groups. The incidence of left ventricular ejection fraction 50% was positively correlated with age, but there was no statistical significance in the difference of age groups with the higher group of.1.3 Gensini scores, the age was increased at 1-3 years, and the score was along with the year. The age increased, and the difference in each score group was statistically significant. The prevalence of diabetes increased with the increase of Gensini score, and the ratio was 16.9%, 23.6%, 29.2%, 30.3%. The incidence of blood lipid disorder was 21.6%, 25%, 25%, 28.4%, but the difference between the scores of blood lipid disorder was 21.6%, 25%, 25%, 28.4%. There was no statistical significance, Gensini score was positively correlated with the number of stent placement and the number of coronary lesions, and there was a significant difference in the integration group. The Gensini score was positively correlated with the admission of myocardial infarction, and there was a significant difference in the integration group.2. The follow-up case was 9.1% for 1 years of drug use, and the incidence of MACCE was 9.1%. The rate was 89.47%, the difference was statistically significant; the patients who did not obey the doctor's advice to control blood lipid were 36.80%, the incidence of MACCE was 61.06%, and the difference was statistically significant. The incidence of MACCE was 88.24%, and the difference was statistically significant; the patients who did not obey the doctor's advice to take the blood pressure drugs accounted for 35.50%, MACC The incidence of E was 36.70%, the difference was not statistically significant; the patients who did not obey the doctor's advice to control blood sugar accounted for 4.49%, and the incidence of MACCE was 100%. There was no statistically significant difference in the occurrence of.2.2 MACCE. The results of single factor analysis showed that age, hypertension, diabetes, dyslipidemia, hyperuricemia, and irregular medication (double anti drug, Control blood lipid drug, control blood uric acid drug, left ventricular ejection fraction 50%, heart function grade high, BNP more than 400pg/L, high sensitive C reactive protein patients in 1~2 years after the operation, there were significant correlation between MACCE and the patients without the above risk factors, the difference was statistically significant, the x 2 value was 23.951,6.140,4.527,4.708, 13.809, (62.878,64.248,41.086), 4.954,7.913,8.792,9.327, P value 0.05. age, hyperuricemia, left ventricular ejection fraction 50%, hyperlipidemia, and diabetes are the risk factors of MACCE within 2 years after PCI for patients with coronary heart disease more than 65 years old, OR values are 1.117,3.206,1.944,3.874,2.461, P 0.05.[conclusion]1, basic disease of elderly patients with coronary heart disease. Many diseases, such as hypertension, diabetes, hyperuricemia, dyslipidemia and other diseases, serious coronary artery disease, high proportion of 3 branches and multiple branches, most of which are hospitalized with myocardial infarction and critical condition. We should strengthen the prevention and screening of coronary heart disease in the elderly, find and treat.2 in the elderly coronary heart disease in time, and Gensini score can be used to better evaluate the crown. The severity of pulse disease, age, diabetes and dyslipidemia are positively correlated with the Gensini score, indicating that the 3 groups have a promoting effect on the severity of coronary artery disease, the more serious the coronary artery disease is, the greater the possibility of entering the hospital with myocardial infarction, the more.3, and the high rate of double anti platelet and hypoglycemic drugs in the elderly patients with coronary heart disease, and the antihypertensive drugs. The rate of hyperuricemia was poor, and the rate of hyperuricemia was poor. 1 years of double anti drug drug was associated with the occurrence of MACCE in 2 years. The relationship between the 1 years and the irregular use of lipid-lowering drugs was most closely related. The clinical attention should be paid to the compliance of the patients after PCI, age, hypertension, dyslipidemia, diabetes, hyperuricemia. Cardiac insufficiency may be a risk factor for MACCE in elderly patients with coronary heart disease within 2 years after PCI.

【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R541.4

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2 沈忱;白介素-37與冠心病的相關性及其在疾病中的作用研究[D];暨南大學;2017年

3 韓國鑫;線粒體基因突變與青年冠心病相關性研究[D];中國人民解放軍醫(yī)學院;2017年

4 任云霞;冠心病合并亞臨床甲狀腺功能減退癥患者的臨床特點及預后[D];山西醫(yī)科大學;2017年

5 唐天娜;張明雪教授從陽虛論治冠心病合并慢性腎臟病的經(jīng)驗總結[D];遼寧中醫(yī)藥大學;2017年

6 趙良偉;丁書文教授關于冠心病伴出汗證治研究[D];山東中醫(yī)藥大學;2017年

7 梅湘凝;中性粒細胞/淋巴細胞比值、脂蛋白相關磷脂酶A2與2型糖尿病伴冠心病的相關性研究[D];鄭州大學;2017年

8 董靜璇;載脂蛋白E基因與冠心病患者的相關性研究[D];山西醫(yī)科大學;2017年

9 鄒冰;探討頸動脈內中膜厚度及斑塊與冠心病的相關性[D];山西醫(yī)科大學;2017年

10 馬卓;血清血管內皮生長因子在不同類型冠心病的差異分析[D];華北理工大學;2017年

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