高龄老年住院冠心病患者二级预防抗血小板治疗现况10年对比

目的了解高龄老年冠心病患者抗血小板药物治疗现况,并与10年间结果对比,为改进冠心病二级预防工作提供依据。方法选择2014年1月~5月在解放军总医院心内科就诊≥80岁冠心病患者,调查抗血小板药物的使用率、种类及联合用药等情况。结果共收集447例患者,男性420例(94.0%),女性27例(6.0%),年龄(88.5±4.8)岁,体质量指数(23.5±4.0)kg/m2,≥24 kg/m2者占47.4%。(1)抗血小板药物总使用率为75.4%,与2005年、2012年相比均有明显提高(P0.05);(2)危险因素抗血小板药物使用率:高血压77.6%,脑卒中/短暂性脑缺血78.4%,糖尿病83.4%,血脂紊乱14.3%,吸烟72.3%;各危险因素抗血小板药物使用率均有明显提高(P0.01);(3)危险因素达标率:血压42.2%,血糖47.3%,总胆固醇37.5%,低密度脂蛋白胆固醇40.6%。与2012年比较,各危险因素治疗率及血压达标率明显偏低(P0.01),血脂达标率明显升高(P0.05);(4)二级预防药物使用率:硝酸酯类66.2%,β受体阻滞剂32.0%,调脂药60.0%,血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体阻断剂25.5%/31.3%,除β受体阻滞剂外均高于2012年。结论高龄老年冠心病患者抗血小板药物使用率较10年前有所提高,二级预防药物使用率及危险因素控制达标率均有所改善,但依指南推荐目标仍需加强。

Utilization of antiplatelet therapy in the very old patients with coronary heart disease compared with 10 years ago

Objective To investigate the utilization of antiplatelet therapy in the very old patients with coronary heart disease （CHD） and compared with the results within 10 years. Methods Patients aged over 80 from cardiology department during January to May of 2014 were selected. The utilization of anti-platelet drugs and other secondary prevention drugs were analyzed and compared with the results in 2005 and 2012. Results 447 patients＇ data were collected. Among them,male was 420 cases （94.0%）,female was 27 cases （6.0%）,aged （88.5 ± 4.8） years. Their body mass index was （23.5 ± 4.0） kg/m^2,over 24kg/m^2 accounted for 47.4 %. （1） The total ratio of anti-platelet drugs was 75.4% ,which was significantly improved compared with 2005 and 2012 （P 〈 0.05）. （2） Antiplatelet drugs usage in those with risk factors：hypertension 77.6%,stroke / TIA 78.4% ,diabetes 83.4%, dyslipidemia 14.3%, and smoking 72.3%. Compared with 2005, the former two were significantly higher （P 〈 0.01 ,P 〈 0.05）,and the latter three were lower （P 〈 0.01）. Anti-platelet drugs usage was significantly improved too （P 〈 0.01）. （3） The ratio to achieve the goal of risk factors： blood pressure 42.2% ,glucose 47.3% ;TC 37.5%, LDL-C 40.6%. The ratio of blood pressure was lower compared with 2012, while LDL-C was higher. （4） The ratio of other drugs＇utilization：nitrates 66.2%,β-blockers 32.0%,lipid-lowering drugs 60.0%, ACEI/ARB 25.5% /31.3 %. All of the data were higher than 2012 exceptl3-blockers. Conclusion The utilization of anti-platelet drugs in the very old patients with CHD has increased compared with 2005 and 2012. Although secondary prevention drugs of CHD and the ratio to achieve the goal of risk factors are improved ,they still will be paid special attention recommended by the guidelines.