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中国人民解放军总医院老年心血管病研究所
中国科技出版传媒股份有限公司
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中华老年多器官疾病杂志编辑委员会
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创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
秦留安,席少枝,王绪云,刘佳,刘军,尹彤.某干休所高龄冠心病和房颤患者抗栓治疗情况调查[J].中华老年多器官疾病杂志,2018,17(3):188~191
某干休所高龄冠心病和房颤患者抗栓治疗情况调查
Survey on status of antithrombotic therapy in extremely elderly patients with coronary heart disease and atrial fibrillation
投稿时间:2017-09-19  修订日期:2017-10-10
DOI:10.11915/j.issn.1671-5403.2018.03.041
中文关键词:  冠心病;心房颤动;血小板聚集抑制剂;抗凝药;高龄
英文关键词:coronary heart disease; atrial fibrillation; platelet aggregation inhibitors; anticoagulants; extremely elderly
基金项目:国家老年疾病临床医学研究中心开放课题(NCRCG-PLAGH-2017002)
作者单位E-mail
秦留安 解放军总医院心血管内科,北京 100853;国家老年疾病临床医学研究中心, 北京 100853  
席少枝 解放军总医院心血管内科,北京 100853;国家老年疾病临床医学研究中心, 北京 100853  
王绪云 解放军总医院心血管内科,北京 100853;国家老年疾病临床医学研究中心, 北京 100853  
刘佳 解放军总医院心血管内科,北京 100853;国家老年疾病临床医学研究中心, 北京 100853  
刘军 解放军总医院心血管内科,北京 100853;国家老年疾病临床医学研究中心, 北京 100853  
尹彤 解放军总医院心血管内科,北京 100853;国家老年疾病临床医学研究中心, 北京 100853 yin1tong1@163.com 
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中文摘要:
      目的 分析某军队干休所高龄冠心病(CHD)和心房颤动(AF)患者抗栓治疗的现状,为制定针对该人群的个体化治疗方案提供参考依据。方法 募集2015年7月至2016年7月生活于某军队干休所的高龄(≥80岁)患者190例,男性167例,女性23例,年龄81~98(87.8±3.6)岁,通过收集临床病历资料,了解不同类型冠心病患者和房颤患者抗栓治疗情况。采用 SPSS 18.0统计软件对数据进行分析。组间比较采用χ2检验。结果 190例患者中CHD患者占41.05%(78/190),AF患者占14.74%(28/190),AF合并CHD患者占4.21%(8/190)。 CHD患者中91.02%(71/78)接受了抗栓治疗,其中69.23%(54/78)患者采用双联抗血小板治疗(DAPT)方案,17.95%(14/78)患者单用阿司匹林或氯吡格雷治疗,1.28%(1/78)患者使用华法林治疗,2.56%(2/78)患者使用其他抗血小板药物。8.97%(7/78)患者未使用任何抗栓药物,无1例患者使用新型强效抗血小板药替格瑞洛。AF患者中28.57%(8/28)接受抗凝治疗,其中21.43%(6/28)使用华法林,7.14%(2/28)使用新型口服抗凝药。60.71%(17/28)接受抗血小板治疗,其中21.43%(6/28)患者接受DAPT方案,7.14%(2/28)的患者使用氯吡格雷,32.14%(9/28)患者使用阿司匹林。10.71%(3/28)患者未接受任何抗栓治疗。8例AF合并CHD患者中,2例使用华法林或肝素联合DAPT方案,4例使用DAPT方案,2例仅使用阿司匹林治疗。3组不同冠心病类型患者抗栓治疗比较结果表明,稳定性冠心病(SCAD)患者中单用阿司匹林者占25.00%(9/36),明显高于急性冠脉综合征(ACS)和经皮冠状动脉介入(PCI)术后1年患者,差异具有统计学意义(P=0.005)。PCI术后1年患者中使用DAPT 方案占92.86%(26/28),明显高于SCAD和ACS患者,差异具有统计学意义(P=0.000)。结论 尽管军队干休所医疗条件好,高龄CHD和AF患者抗栓治疗仍不够规范,新型口服抗血小板和抗凝药物应用经验不足。
英文摘要:
      Objective To investigate the status of antithrombotic therapy in the extremely elderly patients with coronary heart disease (CHD) and atrial fibrillation (AF) from a military retired cadres’ sanatorium. Methods A total of 190 extremely elderly patients (≥80 years old) who lived in a military retired cadres’ sanatorium from July 2015 to July 2016 were recruited in this study. They were 167 males and 23 females, and at an age of 81-98 (87.8±3.6) years. Their clinical data, including different types of CHD and antiplatelet and anticoagulant therapy were collected and analyzed. SPSS statistics 18.0 was used to perform the statistical analysis. Chi-square test was employed for comparison between groups. Results Among the 190 elderly individuals, those with CHD accounted for 41.05% (78/190), AF for 14.74%(28/190), and AF accompanied with CHD for 4.21%(8/190). In the patients with CHD, 91.02%(71/78) received antithrombotic therapy, including 69.23%(54/78) with dual antiplatelet therapy (DAPT) and the other 17.95%(14/78) with aspirin or clopidogrel treatment; 1.28%(1/78) patients were treated with warfarin, 2.56%(2/78) patients used other antiplatelet drugs. 8.97%(7/78) patients did not receive any antithrombotic drugs, and no one was treated with novel potent antiplatelet agent ticagrelor. In the patients with AF, 28.57%(8/28) were administrated with anticoagulant agents, including 21.43%(6/28) with warfarin, and 7.14%(8/28) with new oral anticoagulation agent. Among them, 60.71%(17/28) were treated with antiplatelet agent, accounting for 21.43%(6/28) with DAPT, 7.14%(2/28) with ticagrelor and 32.14% (9/28) with aspirin alone, and 10.71%(3/28) were treated with neither antiplatelet nor anticoagulation agents. In the 8 patients with both AF and CHD, 2 cases was treated with warfarin or heparin combined with DAPT, 4 cases with DAPT, and 2 cases with aspirin alone. Amongthe patients with different types of CHD, aspirin alone was used in 25.00% (9/36) patients of stable coronary artery disease (SCAD), significantly higher than those with acute coronary syndrome (ACS), and those within 1 year after percutaneous coronary intervention (PCI, P=0.005). DAPT protocol was quite common in those (92.86%, 26/28) within 1 year after PCI when compared with those with SCAD and ACS (P=0.000). Conclusion Although the medical condition in military retired cadres’ sanatorium is very good, the antithrombotic therapy is not ideal in the extremely elderly patients with CHD and AF. The experience for novel antiplatelet and anticoagulation agents is insufficient.
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