老年急性心肌梗死经皮冠状动脉介入治疗临床观察.docVIP

老年急性心肌梗死经皮冠状动脉介入治疗临床观察 　　[摘要] 目的 探讨老年急性心肌梗死（acute myocardial infarction，AMI）经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）的疗效及安全性。 方法 选取我院2014年1月～2016年1月老年AMI住院患者80例，一组40例急诊行PCI设为PCI组，另一组40例予药物保守治疗设为保守治疗组，均规范应用阿司匹林和硫酸氢氯吡格雷（波立维）或替格瑞洛（倍林达）、他汀类降脂药、血管紧张素转换酶抑制剂（ACEI）或血管紧张素受体拮抗剂（ARB）、β受体阻滞剂以及质子泵抑制剂等。观察住院期间两种治疗方法的安全性及出院1年内主要的心血管事件（major adverse cardiovascular events，MACE），比较两种治疗方法的优劣。 结果 住院期间，PCI组与保守治疗组比较，出血、肾衰等不良事件无明显增加（P0.05），在严重心律失常、急性左心衰竭、死亡方面略有减少（P0.05），而出院1年内，因急性冠脉综合征（acute coronary syndromes，ACS）再次入院、室壁瘤形成、慢性心衰、死亡方面略有下降（P0.05）。 结论 老年人急性心梗（AMI））尽早实施PCI治疗是安全有效的，优于药物保守治疗。 　　[关键词] 老年人；心肌梗死；经皮冠状动脉成形术；安全性 　　[中图分类号] R541.4 [文献标识码] A [文章编号] 1673-9701（2017）30-0019-04 　　[Abstract] Objective To investigate the efficacy and safety of percutaneous coronary intervention（PCI）in the treatment of elderly acute myocardial infarction（AMI）. Methods 80 elderly hospitalized patients with AMI who were in our hospital from January 2014 to January 2016 were selected. 40 patients in one group were given emergency PCI as PCI group， and 40 patients in another group were given conservative medical treatment as conservative treatment groups. The patients were given standardized application of aspirin and clopidogrel hydrogen sulfate（Plavix）or Ticagrelor（Brilinta）， statins lipid-lowering drugs， angiotensin converting enzyme inhibitor（ACEI）or angiotensin receptor antagonist（ARB）， β-blockers and proton pump inhibitors， etc. The safety of the two treatments during hospitalization and the major adverse cardiovascular events（MACE）one year after discharge were observed. The advantages and disadvantages of the two treatment methods were compared. Results During hospitalization， compared with the conservative treatment group， bleeding， renal failure and other adverse events were not significantly increased in the PCI group（P0.05）. Severe arrhythmia， acute left heart failure， and death were slightly reduced（P0.05）. One year after discharge， re-admission due to acute coronary syndromes（ACS）， ventr