百岁及近百岁老年患者抗血小板药物二级防治应用现状及安全性和有效性分析

目的 探讨百岁及近百岁老年患者抗血小板药物二级防治应用现状及有效性和安全性.方法 入选百岁及近百岁老年患者135例,根据临床应用抗血小板药物情况分为规范用药组75例和未规范用药组60例.再根据是否发生出血事件分为出血组43例和未出血组92例,随访6个月,详细记录患者基线资料、出血事件和血栓栓塞性事件.采用多因素Cox比...     

老年患者应用抗血小板药物的收益与风险

<正>随着人们生活方式的改变以及社会老龄化进程的加速,缺血性心、脑血管疾病发生率及病死率日趋上升。老年患者是缺血性心、脑血管病的高发人群,病死率也高于一般人群。越来越多的证据表明,抗血小板药物对防治动脉粥样硬化性血栓事件可以起到至关重要的作用,尤其是在老年人中的应用也越来越广泛。然而,抗血小板药物的应用也存在很大的潜在风险,例如消化系统溃疡出血以及其他重要脏器出血如脑出血等,甚至是致命性的。由于高龄老年患者特殊的生理代谢特点,更易出现严重不良反应,从而使其依从性降低导     

抗血小板药物研究进展

目前,急性冠脉综合征标准治疗方案是应用双联抗血小板药物基础上联合抗凝药物,即阿司匹林联合血小板二磷酸腺苷(ADP)受体P2Y12阻滞剂联合肝素类或戊糖类药物,对于一些高危患者还需适当加用血小板膜糖蛋白(GP)Ⅱb/Ⅲa受体拮抗剂。缺血性疾病的二级预防也要求使用一定时期的双联抗血小板药物治疗,之后终生服用合适剂量的阿司匹林或氯吡格雷。然而,抗血小板药物的应用是一把"双刃剑",在发挥治疗作用的同时也存在很大的潜在出血风险,如脑卒中及严重内脏出血等,因此,选择应用抗血小板药物时,应权衡利弊、综合分析,在争取获得最优治疗效果的同时,最大限度减少出血等不良反应的发生。     

老年患者抗血小板治疗状况调查

目的探讨老年患者基础疾病、服用抗血小板药物类型和剂量、影响抗血小板治疗效果的药物、血小板聚集功能检查结果及出血事件的发生情况,为老年患者的抗血小板治疗提供改进和指导。方法选择规律服用抗血小板药物并定期进行血小板聚集功能测定的老年患者1404例,归类分析基础疾病、服用抗血小板药物类型和剂量、同时联用可能影响抗血小板治疗效果的药物、血小板聚集功能检查结果及出血事件的发生情况。结果与未服用抗血小板药物患者比较,服用阿司匹林或氯吡格雷以及两药联用的患者,血小板聚集功能水平明显下降(P<0.01);服用氯吡格雷同时联用质子泵抑制剂(PPI)和(或)他汀类药物的患者,二磷酸腺苷诱导血小板聚集功能水平下降幅度均低于仅服用氯吡格雷的患者(P<0.01);服用氯吡格雷同时联用PPI和(或)他汀类药物的患者,以及服用氯吡格雷+阿司匹林+PPI和(或)他汀类药物的患者,二磷酸腺苷诱导血小板聚集功能水平下降幅度均低于仅服用氯吡格雷+阿司匹林的患者(P<0.01)。结论老年患者中仍存在一定比例的阿司匹林和氯吡格雷抵抗;同时服用PPI和(或)他汀类药物,对氯吡格雷的抗血小板治疗效果有潜在不利影响;合理的药物联用原则,高度个体化的抗血小板治疗方式,以及更加精确的血小板功能检测方法,需要尽快在临床推广应用。     

75岁以上老年冠心病患者应用不同抗血小板药物临床疗效观察

目的观察75岁以上老年冠心病患者应用不同抗血小板药物的临床疗效。方法选取2010年1月~2013年12月在我院住院治疗的208例75岁以上老年冠心病患者,随机分为5组,阿司匹林组44例、氯吡格雷组42例、双联抗血小板组(双联组)38例、双联抗血小板+质子泵抑制剂组(双联+PPI组)43例和对照组41例。比较用药后各组血小板聚集率、临床疗效及消化道出血事件等指标。结果与对照组用药前比较,双联组及双联+PPI组用药后花生四烯酸及二磷酸腺苷诱导的血小板聚集率均显著下降(P<0.05);各组临床总有效率比较,阿司匹林组、氯吡格雷组、双联组及双联+PPI组均显著优于对照组(88.6%、90.5%、94.7%、93.0%vs 51.2%),差异有统计学意义(P<0.05)。双联组消化道出血事件发生率高于对照组(26.3%vs 7.3%,P<0.05),双联+PPI组消化道出血的发生率显著低于双联组(9.3%vs 26.3%,P<0.05)。结论在75岁以上老年冠心病人群中,单独应用一种抗血小板药物是安全有效的。双联抗血小板治疗联合应用质子泵抑制剂能显著降低消化道出血的发生率。     

高龄男性住院患者应用抗血小板药物情况调查

目的对于高龄男性内科住院患者应用抗血小板药物的现状进行调查,了解抗血小板药物应用现状。方法选择在我院老年内科住院的75岁以上男性患者315例进行登记调查,其中有用抗血小板药物适应证的共270例,对其应用抗血小板药物情况进行调查分析。结果在接受调查的270例中,只有143例(50.2%)在应用抗血小板药物。结论在当前高龄男性内科住院患者中,抗血小板药物应用不满意。     

硝酸甘油对老年冠心病患者的抗血小板聚集作用

硝酸甘油对老年冠心病患者的抗血小板聚集作用杨杰孚汪芳邢宝利许晓东潘洁郑天林一、对象和方法病例选自１９９５年９月至１９９６年３月。老年组２０例，男１７例，女３例；年龄６０～７５岁，平均６６±６岁。其中急性心肌梗死８例，心绞痛１２例。老年前期组１３例，男...     

血小板高反应性对冠心病合并糖尿病患者介入治疗术后不良事件的预测

目的探讨血小板高反应性对冠心病合并糖尿病患者行PCI术后发生临床终点事件的预测价值。方法回顾性分析行PCI的患者263例,平均随访(362.6±66.7)d。根据是否诊断为糖尿病,分为糖尿病组61例和非糖尿病组202例。二磷酸腺苷(ADP)诱导的血小板高反应性(HPR)定义为血小板聚集率≥50%。结果糖尿病组患者ADP诱导的HPR比例显著高于非糖尿病组(27.9%vs 16.3%,P=0.044)。糖尿病组HPR患者PCI术后主要不良心血管事件(MACE)发生率显著高于非HPR患者(35.3%vs 6.8%,P=0.016),HPR与PCI术后发生MACE的相关系数在糖尿病组与非糖尿病组中分别为0.361(P=0.01,95%CI:1.6~64.7)、0.277(P=0.209,95%CI:0.6~7.5)。结论 HPR与MACE的关系在糖尿病组要强于非糖尿病组。     

三联抗血小板治疗对老年女性糖尿病急性心肌梗死患者的疗效探讨

目的探讨三联抗血小板治疗(TAPT)对老年女性糖尿病急性ST段抬高型心肌梗死(ST-elevation myocardial infarction,STEMI)PCI的近期疗效和安全性。方法选择2013年1月～2018年12月入住郑州人民医院CCU行急诊PCI的老年女性糖尿病STEMI患者162例,依据CRUSADE评分分为2组:CRUSADE评分≥31分患者69例[女性双联抗血小板治疗(DAPT)组],给予阿司匹林+替格瑞洛治疗;CRUSADE评分30分患者93例(女性TAPT组),给予阿司匹林+替格瑞洛+替罗非班治疗;选择同期住院行急诊PCI的老年男性糖尿病STEMI患者97例(男性TAPT组),CRUSADE评分30分,用药同女性TAPT组。对3组临床资料、冠状动脉病变特征、住院时间和并发症发生率进行比较。结果男性TAPT组梗死前心绞痛发生率显著高于女性DAPT组和女性TAPT组(19.6%vs 2.9%、4.3%,P0.05)。女性DAPT组术后住院时间、梗死后心绞痛、严重心律失常、心力衰竭和心源性休克发生率显著高于男性TAPT组和女性TAPT组,住院择期二次PCI、住院再梗死、支架内血栓和30d病死率显著高于男性TAPT组(P0.05)。女性TAPT组总出血和中度出血发生率显著高于男性TAPT组和女性DAPT组(21.5%vs 7.2%、8.7%,8.6%vs 1.0%、1.4%,P0.05)。结论老年女性糖尿病STEMI患者PCI术后TAPT缺血性并发症发生率显著低于女性DAPT患者,但是出血事件发生率显著高于女性DAPT和男性TAPT患者。     

高龄老年冠心病患者抗血小板药物使用及效果

目的分析高龄老年冠状动脉粥样硬化性心脏病(冠心病)患者服用抗血小板药物情况及治疗效果。方法回顾性纳入2013年6月至2014年12月间在北京军区总医院干四科住院治疗的高龄老年(年龄≥75岁)冠心病患者75例,分为双联抗血小板组(n=32)、单用阿司匹林组(n=16)、单用氯吡格雷组(n=12)及未服用抗血小板药物组(n=15)。比较双联抗血小板组、阿司匹林组、氯吡格雷组患者凝血功能及血栓弹力图指标。结果 75例高龄老年冠心病患者中双联抗血小板占42.7%,单用阿司匹林占21.3%,单用氯吡格雷占16.0%,未服用抗血小板药物占20.0%。双联抗血小板组、阿司匹林组、氯吡格雷组3组患者在年龄、性别构成、常规凝血指标及血小板计数方面无统计学差异(P0.05)。97.9%服用阿司匹林治疗者花生四烯酸(AA)诱导的血小板聚集抑制率(IRAA)50%,70.5%服用氯吡格雷治疗者二磷酸腺苷(ADP)诱导的血小板聚集抑制率(IRADP)≥30%。双联抗血小板组、阿司匹林组、氯吡格雷组3组患者R、K、Angle、MA值水平无统计学差异(P0.05),MAADP、IRADP、IRAA存在统计学差异(P0.05),双联抗血小板组MAADP显著低于阿司匹林组及氯吡格雷组(P0.05),IRADP显著高于阿司匹林组及氯吡格雷组(P0.05),氯吡格雷组IRAA显著低于双联抗血小板组及阿司匹林组(P0.05)。结论高龄老年冠心病患者抗血小板药物使用率较高,阿司匹林与氯吡格雷均获得较好的抗血小板疗效,但阿司匹林反应低下的发生率明显低于氯吡格雷。     

Prevalence of pain in elderly hospitalized patients

Several studies indicate that pain, although very common in the elderly, is under-treated, because it is considered as a concomitant effect of aging. This study aimed to evaluate the prevalence of pain among patients in eight Italian geriatric hospital departments, correlated to prescribed therapy. We enrolled 387 patients in the study, 367 of whom were evaluated. Each patient's recovery, co-morbidity, pain intensity, prescribed therapy, side effects, duration of pain, and efficacy of therapy were monitored during two 15-day periods from 15 July to end of August 2008, and from 1 October to 15 November 2008. The results of this study confirmed that hypertension, cardiopathic disease, diabetes, and chronic obstructive pulmonary disease (COPD) are common pathologies, and that pain is present in 67.3% of those recovered in geriatric departments. In general, however, pain is not treated. Indeed only 49% of those with pain had any type of treatment, which was adequate for the pain intensity. In fact 74.5% of patients considered the therapy to be of low or no efficacy. These data demonstrate the presence of pain in a high percentage of elderly patients, which is either not treated, or treated inadequately. Controlling pain is essential in elderly patients in order to allow a normal life and an active role in family and society. The main conclusion is that pain is often poorly considered in the elderly, thus leading to a dangerous under-treatment. We want to underline the crucial clinical impact of such under-treatment in elderly patients.     

Prevalence of pain in elderly hospitalized patients

Several studies indicate that pain, although very common in the elderly, is under-treated, because it is considered as a concomitant effect of aging. This study aimed to evaluate the prevalence of pain among patients in eight Italian geriatric hospital departments, correlated to prescribed therapy. We enrolled 387 patients in the study, 367 of whom were evaluated. Each patient's recovery, co-morbidity, pain intensity, prescribed therapy, side effects, duration of pain, and efficacy of therapy were monitored during two 15-day periods from 15 July to end of August 2008, and from 1 October to 15 November 2008. The results of this study confirmed that hypertension, cardiopathic disease, diabetes, and chronic obstructive pulmonary disease (COPD) are common pathologies, and that pain is present in 67.3% of those recovered in geriatric departments. In general, however, pain is not treated. Indeed only 49% of those with pain had any type of treatment, which was adequate for the pain intensity. In fact 74.5% of patients considered the therapy to be of low or no efficacy. These data demonstrate the presence of pain in a high percentage of elderly patients, which is either not treated, or treated inadequately. Controlling pain is essential in elderly patients in order to allow a normal life and an active role in family and society. The main conclusion is that pain is often poorly considered in the elderly, thus leading to a dangerous under-treatment. We want to underline the crucial clinical impact of such under-treatment in elderly patients.     

标准化视频宣教在老年患者肠镜检查肠道准备中的应用

目的 探究标准化视频宣教对老年患者肠镜检查肠道准备的应用效果。方法 将112例年龄≥60岁的肠镜检查患者随机分为研究组(n=56)与对照组(n=56),依照《中国消化内镜诊疗相关肠道准备指南》,给予患者复方聚乙二醇电解质散(Polyethylene Glycol Electrolyte Powder,商品名：和爽)分次口服,对照组通过传统纸质和口头宣教,研究组在对照组基础上增加标准化视频宣教,比较两组渥太华肠道准备量表(OBPS)评分、不良反应发生率、肠镜知识回答正确率和患者满意度。结果 两组患者肠道准备清洁质量比较,研究组OBPS总分平均分(2.88±2.10)低于对照组OBPS总分平均分(4.75±2.27),表明研究组肠道准备质量优于对照组,差异有统计学意义(P<0.01)。研究组和对照组患者出现恶心、呕吐、饥饿感、头晕、肛门疼痛、心理压力,差异均有统计学意义(P<0.05),需要注意的是两组腹胀出现率均>30%,但差异无统计学意义(P>0.05)。研究组的肠镜知晓率和患者满意度均高于对照组,差异均有统计学意义(P<0.05)。结论 将标准化视频宣教...     

Delirium risk factors in elderly hospitalized patients

OBJECTIVE: Delirium is frequent in elderly hospitalized patients. Many studies have examined its risk factors, but results have been quite variable. Thus, the goal of this study is to identify through systematic literature review the risk factors associated with the development of delirium in hospitalized geriatric patients. MEASUREMENTS AND MAIN RESULTS: First, MEDLINE/CURRENT contents databases were screened for relevant articles published from 1966 to December 1995, and from bibliographies of identified articles additional reports were selected. Second, the reports were screened by two different investigators and retained only if meeting the five following criteria: (1) original research in French or English; (2) prospective study; (3) patients over age 50; (4) minimum of one risk factor examined; (5) acceptable definition of delirium. Third, the methodology of each study was graded according to specific criteria for risk factor studies. Fourth, risk factors were identified and tabulated, unadjusted odds ratios (ORs) were computed, and where appropriate a combined OR with the Mantel-Haenszel estimator was calculated. Twenty-seven articles were retained meeting all of the above criteria. Among these studies, 11 were done on medical patients, 9 on surgical patients, 2 on medical and surgical patients, and 5 on psychiatric patients. In total 1,365 subjects with delirium were studied. Sixty-one different risk factors were examined, the five most common being dementia, medication, medical illness, age, and male gender. Mantel-Haenszel estimator was calculated for 10 risk factors, the most strongly associated being dementia (OR 5.2; 95% confidence interval [CI] 4.2, 6.3), medical illness (OR 3.8; 95% CI 2.2, 6.4), alcohol abuse (OR 3.3; 95% CI 1.9, 5.5), and depression (OR 1.9; 95% CI 1.3, 2.6). Methodologic weaknesses were present in many studies. CONCLUSIONS: Despite methodologic limitations, certain risk factors for delirium seem to be consistent and could help identify high-risk patients. These risk factors include dementia, advanced age, and medical illness. Other risk factors appear to play a contributory role in the development of delirium in elderly hospitalized patients. Presented at the American Psychiatric Association annual meeting, New York, NY, May 1996. The authors thank Brigitte Beaudet, Audiovisual Department, and Dr. Jane McCusker, Department of Clinical Epidemiology, for their assistance in completing this article.     

New antiplatelet drugs

Antiplatelet drugs are used in a wide range of disorders, either as sole agents or as adjuncts to other therapies. Aspirin has been shown to be clinically effective in a number of ischaemic conditions and has been in use for many years. The newer agents, ticlopidine and clopidogrel (which are thought to inhibit ADP-mediated platelet reactions) are also effective and may prove to be superior to aspirin in certain indications. However, ticlopidine in particular has a different spectrum of side-effects, which may eventually limit its widespread use. The Gp IIb/IIIa antagonists have been most extensively investigated in the acute coronary syndromes, and shown to significantly improve outcome. Most of these studies have utilized agents which need to be given parenterally, and subsequently oral compounds are currently being developed. A number of other antiplatelet drugs such as prostacyclin and its analogues, as well as thromboxane inhibitors have been studied over the years, but overall they have failed to demonstrate any real clinical advantage.     

老年查体人群抗血小板药物应用的现况分析

目的调查分析老年查体人群中抗血小板药物应用现况及起效概况。方法入选2015年6月至2015年8月期间在解放军总医院南楼体检的老年人(≥60岁)共955人。依据是否服用抗血小板药物及药物种类分为4组:阿司匹林组(n=368),氯吡格雷组(n=115),双抗(阿司匹林和氯比格雷)组(n=43)和无药物组(n=429)。收集基线资料并完成血栓弹力图(TEG)测定,描述分析抗血小板药物应用及有效性情况,探讨影响抗血小板疗效的相关临床指标。结果 4组人群间的年龄分布、吸烟者比例以及具有卒中、冠心病、糖尿病、高脂血症病史者的比例、白细胞(WBC)计数、血小板(PLT)计数、总胆固醇、低密度脂蛋白胆固醇(LDL-C)、空腹血糖、肌酐、估算肾小球滤过率(eGFR)和糖化血红蛋白(HbA1c)差异有统计学意义(P0.05),而凝血指标差异无统计学意义(P0.05)。阿司匹林组的花生四烯酸(AA)途径几近起效,氯吡格雷组的二磷酸腺苷(ADP)途径以及双抗组的AA途径和ADP途径均在起效范围内。氯吡格雷组的有效率显著高于阿司匹林组(76.52%vs45.92%),差异具有统计学意义(P0.05)。logistic回归分析发现WBC、PLT、活化部分凝血活酶时间(APTT)和LDL-C增加出血风险,年龄、PLT、eGFR、HbA1c和APTT增加血栓风险。结论抗血小板药物的使用现况较为满意,可使老年人获益。     

高龄老年住院患者老年综合征特点分析

目的探讨高龄老年住院患者的老年综合征特点。 方法选取新疆维吾尔自治区人民医院2017年6月至2018年5月收治的老年患者235例,其中80～95岁患者117例（高龄老年组）,65～79岁患者118例（普通老年组）,比较两组患者的老年综合征特点。组间计量资料的比较采用t检验,计数资料的比较采用χ²检验,影响因素分析采用二元Logistic回归分析。 结果两组患者的一般资料具有可比性（P>0.05）;高龄老年组患者认知障碍、尿失禁、视觉障碍、听力损失、步态平衡障碍及肌少症的发生率明显高于普通老年组患者（χ²=12.254、6.871、10.647、24.634、6.749、41.979,P<0.05）。Logistic回归分析分析发现,高龄老年组患者随着年龄的增加,其认知障碍、尿失禁、视觉障碍、听力损失、步态平衡障碍及肌少症的发生率也随之增高（P<0.05）;女性尿失禁患病率更高（P<0.05）;男性步态平衡障碍和肌少症患病率更高（P≤0.01）;少数民族肌少症患病率更高（P<0.05）;非糖尿病患者尿失禁患病率更高（P<0.05）,糖尿病患者步态平衡障碍和肌少症患病率更高（P≤0.01）;冠心病患者步态平衡障碍患病率更高（P<0.05）;其他疾病仍可影响患者步态平衡障碍和肌少症的患病率（P<0.05或0.01）。 结论不同年龄段老年患者的老年综合征不同,且高龄老年患者更易罹患老年综合征,应根据其患病特点评估制定适宜的治疗方案。     

Prognostic implications of hyponatremia in elderly hospitalized patients

Hyponatremia is the most common electrolyte imbalance in elderly in-patients. We hypothesized that hyponatremia was independently associated with increased length of stay and loss of independence or death as measured by failure to return to previous residence. This cohort study measured the prognostic impact of hyponatremia in all patients admitted to two acute geriatric wards. Basic demographic data and serum sodium results were included in multiple linear and logistic regression models for the end-points length of stay and return to previous residence respectively. There were 103 cases (mean age 82, 59% female), of whom 19 (18%) were hyponatremic on admission, but another 24 (23%) became hyponatremic whilst in hospital. Median length of stay was 13 days. Sixty-six (65%) cases returned to the previous residence on discharge, 8 (8%) patients died. Factors independently associated with longer length of stay were increasing age (p=0.016), lower admission serum sodium (p=0.012) and larger drop in serum sodium during the admission (p<0.001). Only a larger drop in serum sodium was significantly associated with failure to return to previous residence (p<0.001). We conclude that hyponatremia in elderly in-patients is common. Drop in serum sodium during admission was strongly associated with increased length of stay and loss of independence.     

Clinical significance of homocysteine in elderly hospitalized patients

Serum homocysteine levels, which increase with age, are now recognized as a vascular risk factor and are related to the development of heart failure and dementia in the elderly. However, relatively low serum homocysteine levels have also been reported to be an adverse prognostic factor in dialysis patients. The objective of the study was to analyze the prevalence, clinical significance, and prognostic value of serum homocysteine levels in patients older than 65 years, admitted to a general internal medicine hospitalization unit. We studied 337 hospitalized patients, 184 males and 153 females, aged 77.2+/-0.4 years, whose admission was not determined by an acute vascular event. We recorded past vascular events and vascular risk factors. We determined the body mass index (weight in kilograms divided by the square of height in meters), and cholesterol, triglyceride, folate, vitamin B12, and homocysteine levels. We also studied 36 control subjects (18 males and 18 females) of similar age. After discharge, we assessed the survival status of 301 patients by telephone recall. Survival curves were plotted by the method of Kaplan and Meier. Median survival was 1186 days. The 15th (9.6 micromol/L) and 50th (14.4 micromol/L) percentiles, as the lowest and highest cut-off points, were empirically defined as those related to a shorter survival. Serum homocysteine concentration was significantly positively correlated with age and serum creatinine and albumin concentrations, and negatively correlated with serum cobalamin and folate concentrations. The average serum homocysteine concentration for the patients group, as a whole, was 16.5+/-0.5 micromol/L, not significantly different from the control group, but with a much greater dispersion, as patients with congestive heart failure or cognitive impairment had higher serum homocysteine concentrations, and patients with sepsis, leukocytosis, and hypoalbuminemia had lower concentrations. Malnutrition was associated both with abnormally high and low homocysteine concentrations, and abnormally low and abnormally high homocysteine concentrations were both associated with higher mortality. In conclusion, low homocysteine levels in elderly non-vitamin-supplemented hospitalized patients should not be interpreted as a protective factor in some individuals. Instead, it may be considered as an effect of an inflammatory-malnutrition process associated with a poor prognosis.