50例75岁以上老年冠心病介入治疗疗效观察(2)
老年冠心病患者常有多支血管病变、发生严重钙化、扭曲和慢性完全闭塞。以往高龄老年人的冠心病治疗往往因合并症多或多支冠状动脉病变等因素而未选择PCI。近年随着介入材料工艺的改进、新型抗血小板药的应用以及手术者技术经验的丰富，高龄冠心病患者即刻手术成功率与成年组相当，适应证已明显放宽[4]。据统计75岁以上患者行介入治疗的病例占19%，与年轻入比较，经皮腔内冠状动脉成形术病死率及并发症有轻度增高。尽管如此，约90%的患者通过经皮腔内冠状动脉成形术后，症状可获明显减轻[5]。本组75岁以上老年患者手术并发症少，成功率达98.0%。郑朝阳等人报道，75岁以上老年患者并发症、手术成功率和病死率均较60～75岁老年人高，提示尽管高龄患者手术成功率高，手术风险仍然较高。高龄冠心病患者介入技术操作难度大，术前应进行仔细研究分析，术中要尽量合理组合多种介入器械的使用。对于高危患者，尤其是当存在左心室功能降低和不稳定斑块时，最好有主动脉内气囊反搏和外科冠状动脉旁路移植术的有力保障。
[参考文献]
[1]Klein LW，Block P，Brindis RG，et al.Percutaneous coronary interventions inoctogenarians in the American College of Cardiology National Cardiovascular DataRegistry:development of a nomogram predictive of in hospital mortality[J].J Am Coll Cardiol,2002,40(3):394-402.
[2]Onner CM,Friesinger C.Aging and the heart In Topol E Text book of cardio-vascular medicine[J].Philadelphia Lippincottraven Publishers,1998,817-840.
[3]Zacek P,Dominik J,Harrer J,et al.Morbidity and mortality in patients 70 years of age and over undergoing isolated coronary artery bypass surgery[J]. Acta Medica(Hradec Kralove),2001,44:109-114.
[4]Voudris VA,Skoularigis JS,Malakos JS,et al.Long term clinical outcome of coronary artery stenting in elderly patients[J].Coronary Artery Dis,2002,13(6):323-329.
[5]Keller NM,Felt F.Coronary disease in the geriatric population[J].Prog Cardiovasc Dis,1996,38(5):407-418.
[6]郑朝阳，陈秋雄，盛小刚，等.75岁以上冠心病患者介入治疗的安全性和疗效观察[J].岭南心血管病杂志，2007,13(3):211-212.
(收稿日期：2008-04-10), 百拇医药(陈永生 雷 励)
[参考文献]
[1]Klein LW，Block P，Brindis RG，et al.Percutaneous coronary interventions inoctogenarians in the American College of Cardiology National Cardiovascular DataRegistry:development of a nomogram predictive of in hospital mortality[J].J Am Coll Cardiol,2002,40(3):394-402.
[2]Onner CM,Friesinger C.Aging and the heart In Topol E Text book of cardio-vascular medicine[J].Philadelphia Lippincottraven Publishers,1998,817-840.
[3]Zacek P,Dominik J,Harrer J,et al.Morbidity and mortality in patients 70 years of age and over undergoing isolated coronary artery bypass surgery[J]. Acta Medica(Hradec Kralove),2001,44:109-114.
[4]Voudris VA,Skoularigis JS,Malakos JS,et al.Long term clinical outcome of coronary artery stenting in elderly patients[J].Coronary Artery Dis,2002,13(6):323-329.
[5]Keller NM,Felt F.Coronary disease in the geriatric population[J].Prog Cardiovasc Dis,1996,38(5):407-418.
[6]郑朝阳，陈秋雄，盛小刚，等.75岁以上冠心病患者介入治疗的安全性和疗效观察[J].岭南心血管病杂志，2007,13(3):211-212.
(收稿日期：2008-04-10), 百拇医药(陈永生 雷 励)