中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2008年
6期
550-553
,共4页
朱中玉%高传玉%陈岩%牛振民%黄克钧%刘煜昊%李牧尉%徐予%周晗%张静%张嘉莹
硃中玉%高傳玉%陳巖%牛振民%黃剋鈞%劉煜昊%李牧尉%徐予%週晗%張靜%張嘉瑩
주중옥%고전옥%진암%우진민%황극균%류욱호%리목위%서여%주함%장정%장가형
冠状动脉介入治疗%二级预防%依从性%长期预后
冠狀動脈介入治療%二級預防%依從性%長期預後
관상동맥개입치료%이급예방%의종성%장기예후
Percutaneous coronary intervention%Secondary prevention%Compliance%Long-term out-come
目的 了解经皮冠状动脉介入治疗(PCI)术后患者对二级预防的依从性及其与长期临床预后的关系.方法 对589例PCI术后患者进行药物治疗、吸烟状况及主要心脏不良事件(MACE)的随访.调查的药物包括阿司匹林、氯吡格雷、血管紧张素酶转换酶抑制剂(ACEI)或血管紧张素Ⅱ受体拮抗剂(ARB)、他汀类药物、B受体阻滞剂、钙通道拮抗剂(CCB)及硝酸酯类6类药物.对术后停药组、未停药组、吸烟组、未吸烟组心脏不良事件的发生率进行对比分析.结果 平均随访时间18.92月,术后99.83%的患者使用氯吡格雷,应用时间为(7.89±4.96)月;阿司匹林、ACEI/ARB、β受体阻滞剂、他汀类药物、CCB及硝酸酯的应用率分别为98.98%、41.94%、63.50%、83.02%、19.69%及46.52%,随访时降到94.4%、35.99%、55.86%、65.87%、17.49%及35.31%;有31例(5.26%)患者完全停止抗血小板治疗;19例(3.23%)停用所有的药物.术前吸烟率为54.16%,随访时为17.83%.停药组和术后吸烟组增加非致死性心肌梗死及MACE的发生率分别为9.68%、19.35%和4.76%、11.43%,与未停药组和戒烟组非致死性心肌梗死及MACE的发生率1.08%、6.45%和0.83%、6.20%比较,差异均有统计学意义(均P＜0.05).结论 冠心病患者在PCI术后对二级预防的依从性良好,但仍有待进一步提高.术后停止抗血小板治疗及继续吸烟者预后差.
目的 瞭解經皮冠狀動脈介入治療(PCI)術後患者對二級預防的依從性及其與長期臨床預後的關繫.方法 對589例PCI術後患者進行藥物治療、吸煙狀況及主要心髒不良事件(MACE)的隨訪.調查的藥物包括阿司匹林、氯吡格雷、血管緊張素酶轉換酶抑製劑(ACEI)或血管緊張素Ⅱ受體拮抗劑(ARB)、他汀類藥物、B受體阻滯劑、鈣通道拮抗劑(CCB)及硝痠酯類6類藥物.對術後停藥組、未停藥組、吸煙組、未吸煙組心髒不良事件的髮生率進行對比分析.結果 平均隨訪時間18.92月,術後99.83%的患者使用氯吡格雷,應用時間為(7.89±4.96)月;阿司匹林、ACEI/ARB、β受體阻滯劑、他汀類藥物、CCB及硝痠酯的應用率分彆為98.98%、41.94%、63.50%、83.02%、19.69%及46.52%,隨訪時降到94.4%、35.99%、55.86%、65.87%、17.49%及35.31%;有31例(5.26%)患者完全停止抗血小闆治療;19例(3.23%)停用所有的藥物.術前吸煙率為54.16%,隨訪時為17.83%.停藥組和術後吸煙組增加非緻死性心肌梗死及MACE的髮生率分彆為9.68%、19.35%和4.76%、11.43%,與未停藥組和戒煙組非緻死性心肌梗死及MACE的髮生率1.08%、6.45%和0.83%、6.20%比較,差異均有統計學意義(均P＜0.05).結論 冠心病患者在PCI術後對二級預防的依從性良好,但仍有待進一步提高.術後停止抗血小闆治療及繼續吸煙者預後差.
목적 료해경피관상동맥개입치료(PCI)술후환자대이급예방적의종성급기여장기림상예후적관계.방법 대589례PCI술후환자진행약물치료、흡연상황급주요심장불량사건(MACE)적수방.조사적약물포괄아사필림、록필격뢰、혈관긴장소매전환매억제제(ACEI)혹혈관긴장소Ⅱ수체길항제(ARB)、타정류약물、B수체조체제、개통도길항제(CCB)급초산지류6류약물.대술후정약조、미정약조、흡연조、미흡연조심장불량사건적발생솔진행대비분석.결과 평균수방시간18.92월,술후99.83%적환자사용록필격뢰,응용시간위(7.89±4.96)월;아사필림、ACEI/ARB、β수체조체제、타정류약물、CCB급초산지적응용솔분별위98.98%、41.94%、63.50%、83.02%、19.69%급46.52%,수방시강도94.4%、35.99%、55.86%、65.87%、17.49%급35.31%;유31례(5.26%)환자완전정지항혈소판치료;19례(3.23%)정용소유적약물.술전흡연솔위54.16%,수방시위17.83%.정약조화술후흡연조증가비치사성심기경사급MACE적발생솔분별위9.68%、19.35%화4.76%、11.43%,여미정약조화계연조비치사성심기경사급MACE적발생솔1.08%、6.45%화0.83%、6.20%비교,차이균유통계학의의(균P＜0.05).결론 관심병환자재PCI술후대이급예방적의종성량호,단잉유대진일보제고.술후정지항혈소판치료급계속흡연자예후차.
Objective To investigate the compliance of secondary prevention and the relationship with the long-term outcomes in patients undergoing percutaneous coronary intervention(PCI).Methods 589 patients undergoing PCI were followed-up,and factors including major adverse cardiac events(MACE)),smoking status and the usage of antiplatelet agents,angiotensin converting enzyme inhibitor(ACEI)/angiotensin Ⅱ receptor blocker(ARB),statins,beta blocker,calcium channel blocker and nitrates were recorded.Results The average follow-up time was 18.92 months.At discharge,588 patients(99.83%)were prescribed clopidogrel for(7.89±4.96)months;there were 31 patients(5.26%)who completely discontinued antiplatelet therapy during follow-up.At discharge,the prescription rate of aspirin,ACEI/ARB,beta blocker,statins,calcium channel blocker and nitrates was 98.98%,41.94%,63.50%,83.02%,19.69%and 46.52%respectively,whereas at follow-up,these were decreased to 94.4%,35.99%,55.86%,65.89%,17.49%and 35.31%.At follow-up,there were still 105 current smokers(17.83%).Complete cessation of antiplatelet therapy and current smoking were related to the increased risk of non-fatal myocardial infarct(9.68%v.s.1.08%,P＜0.01);smoking(4.76%v.s.0.83%,P＜0.01)andMACE(19.35%v.s.6.45%,P＜0.01);smoking(11.43%v.s.6.20%,P＜0.05).Conclusion Most patients can adhere to secondary prevention during follow-up,however,the compliance with secondary prevention should be improved further.Cessation of antiplatelet therapy and current smoking contribute to poor prognosis.
