老年患者抗血小板药物规范化应用现状及影响因素研究

发布时间：2018-04-06 01:33

本文选题：抗血小板药物　切入点：规范化应用　出处：《中国人民解放军医学院》2016年硕士论文

【摘要】：研究背景缺血性心脑血管疾病,尤其是老年人群中冠心病、缺血性卒中等,是目前世界范围内最主要的致死原因之一,而血栓形成是心脑血管疾病发生发展过程中至关重要的环节。抗血小板药物能有效抑制血小板的激活进而抑制血栓形成,是缺血性心脑血管疾病预防和治疗的基石。尽管近年来关于抗血小板药物应用获益的研究越来越多,但与血栓形成有关的心脑血管疾病发病率仍然居高不下,此外,抗血小板药物在发挥有效防治作用的同时，也存在一定的潜在性出血风险,有时这种风险甚至是致命性的。因此,有必要对老年患者抗血小板药物应用的规范化现状进行系统研究,以更好指导临床进行缺血性心脑血管疾病的防治。研究目的通过对老年患者抗血小板药物应用现状进行系统性研究，，分析老年患者抗血小板药物应用的规范化现状,探讨影响规范化应用的因素,为我国老年人合理应用抗血小板药物提供循证医学证据。研究方法选择2014年1月至2016年4月在解放军总医院老年病房住院诊治的2771例患者,对其临床资料进行回顾性分析,首先根据抗血小板药物应用现状进行分组：单用阿司匹林组、单用氯毗格雷组、阿司匹林氯毗格雷联合应用组、未应用抗血小板药物组,然后根据抗血小板药物治疗是否规范进一步分为规范化组与不规范组。了解抗血小板药物应用情况,比较并分析影响阿司匹林、氯毗格雷、双联抗血小板药物治疗的因素。采用均数±标准差或者率和构成比描述抗血小板药物应用现况;采用t检验、方差分析、卡方检验、多因素分析等方法分析组间各个临床资料差异是否具有统计学意义。结果1.2771例研究对象中,应用阿司匹林治疗的患者共2221例,占80.2%：未应用阿司匹林治疗的患者550例,占19.8%;单用阿司匹林648例,占23.4%;冠心病患者中阿司匹林使用率83.3%;缺血性脑血管疾病患者中阿司匹林使用率67.6%;入院时存在吸烟史、饮酒史、肥胖、诊断为冠心病、缺血性卒中、后循环缺血、合并高血压病、高脂血症的患者倾向于应用阿司匹林,入院时年龄75岁、合并消化性溃疡、慢性肾脏病、贫血的患者是影响阿司匹林应用的主要因素。2.2771例研究对象中,应用氯毗格雷治疗的患者共1965例,占70.9%;未应用氯毗格雷治疗的患者806例,占29.1%：单用氯毗格雷407例,占14.7%；冠心病患者中氯毗格雷使用率78.5%；缺血性脑血管疾病患者中氯毗格雷使用率43.5%;入院时存在吸烟史、诊断为冠心病、合并高血压病、高脂血症、慢性肾脏病的患者倾向于应用氯毗格雷,入院时年龄75岁、饮酒史、诊断为缺血性卒中、后循环缺血、合并消化性溃疡、贫血的患者是影响氯毗格雷应用的主要因素。3.2771例研究对象中,应用双联(阿司匹林联合氯吡格雷)抗血小板药物的患者1030例,占心脑血管疾病急性期患者人数的76.7%。冠心病急性期患者双联抗血小板使用率82.6%,缺血性脑病急性期患者双联抗血小板使用率53.1%;高龄患者、女性患者、存在饮酒史的患者应用单联治疗的概率高于双联治疗,急性期患者、诊断为冠心病、不稳定性心绞痛、高脂血症的患者倾向于应用双联抗血小板治疗,诊断为稳定性心绞痛、缺血性卒中、消化性溃疡的患者倾向于应用单联抗血小板治疗,进行介入治疗的患者倾向于应用双联抗血小板治疗,存在出血倾向是单用抗血小板治疗的主要因素。4.2771例研究对象中,规范化应用抗血小板药物的患者共2305例,占83.2%；不规范的患者466例,占16.8%;入院时存在吸烟史、诊断为冠心病、合并糖尿病的患者规范化应用抗血小板药物较好,入院时年龄75岁、进行介入治疗、诊断为外周动脉粥样硬化性疾病、合并贫血的患者往往抗血小板药物规范化应用较差。结论1. 在我院住院的老年患者中,抗血小板药物应用率整体较高,但较既往文献报道有所偏低,阿司匹林和氯毗格雷是目前应用最多的抗血小板药物。2. 冠心病及缺血性脑血管疾病中阿司匹林单独使用及联合使用率均高于氯毗格雷。3. 急性冠脉综合征、PCI术后、急性缺血性脑血管疾病是应用双联抗血小板治疗的主要因素,急性心血管疾病患者双联抗血小板药物联合应用率高于急性缺血性脑血管疾病。4.在我院就诊的老年患者中,83.2%患者能规范化应用抗血小板药物,但仍有16.8%患者抗血小板药物应用存在不规范现象。5.年龄增长、并存消化系统疾病、慢性肾脏疾病、介入治疗、出血顾虑等是影响我院老年患者抗血小板药物规范化应用的主要因素。
[Abstract]:The research background of ischemic cardiovascular disease, especially coronary heart disease in the elderly population, ischemic stroke, is currently the world's most one of the leading causes of death, and thrombosis is of vital importance in the process of the development of cardiovascular and cerebrovascular disease link. Antiplatelet drugs can activate effective platelet inhibition and inhibition of thrombosis, is the cornerstone of prevention and treatment of ischemic cardiovascular and cerebrovascular diseases. In recent years, more and more research about the application of antiplatelet drug benefit, but the formation of the incidence of cardio cerebral vascular disease still remains high, and thrombosis in addition, antiplatelet drugs in the prevention play an effective role at the same time, there is also a potential risk of bleeding must, sometimes the risk is even fatal therefore, it is necessary to study systematically the status of norms on the use of antiplatelet agents in elderly patients, in order to better Guide the clinical treatment of ischemic cerebrovascular disease. The purpose of the study through the systematic research on the status quo of antiplatelet drugs in elderly patients, analysis of the standardized application of antiplatelet drugs in elderly patients with the status quo, to explore the factors affecting the standardized application, provide evidence for rational use of antiplatelet drugs in the elderly in China. 2771 case study methods from January 2014 to April 2016 in hospital of PLA general hospital ward in the elderly patients, the clinical data were retrospectively analyzed, first grouped according to the application status of antiplatelet drugs: aspirin alone group, the Gray group with chlorine, chlorine and aspirin combination group Gray, without the use of antiplatelet drugs group, and then according to the antiplatelet drug therapy whether the standard is further divided into standard group and standard group. To understand the application of antiplatelet drugs The situation, comparison and analysis of the impact of aspirin, chlorine PI Gray, factors of dual antiplatelet therapy. By the mean and standard deviation or rate and constituent ratio described the status of antiplatelet drug application; using t test, variance analysis, chi square test, whether the multi factor analysis method to analyze the clinical data of each group. The difference was statistically significant results 1.2771 cases of research object, application of aspirin in the treatment of patients with a total of 2221 cases accounted for 80.2%, without the use of aspirin in the treatment of patients with 550 cases, accounting for 19.8%; aspirin alone in 648 Cases, accounting for 23.4%; coronary heart disease in patients with aspirin use was 83.3%; the patients with ischemic cerebrovascular disease in the use of aspirin on admission rate of 67.6%; there are smoking history, drinking history, obesity, diagnosis of coronary heart disease, ischemic stroke, posterior circulation ischemia, hypertension, hyperlipidemia patients tend to use aspirin, admission At the age of 75, peptic ulcer, chronic kidney disease, patients with anemia is the main factor affecting the application of aspirin in.2.2771 patients, the application of chlorine Gray in the treatment of patients with a total of 1965 cases, accounting for 70.9%; without the use of chlorine adjoin the Gray in 806 patients, accounted for 29.1%, with Gray 407 PI chloride cases of patients with coronary heart disease, accounted for 14.7%; chlorine utilization rate of 78.5% adjacent to Gray; in patients with ischemic cerebrovascular disease and Gray chlorine utilization rate 43.5%; had smoking history, diagnosed as coronary heart disease, hypertension, hyperlipidemia, chronic kidney disease patients tend to use chlorine adjacent to Gray, was 75 years of age, drinking history, diagnosis of ischemic stroke, posterior circulation ischemia, peptic ulcer, anemia patients are the main factors influencing the application of chlorine Gray.3.2771 cases of the research object, the application of double antiplatelet (aspirin and clopidogrel) 1030 cases of patients with drugs, accounting for number of patients with acute cerebrovascular disease in patients with acute coronary heart disease 76.7%. dual antiplatelet use rate of 82.6% patients with ischemic encephalopathy in acute phase of dual antiplatelet use rate of 53.1%; female patients, elderly patients, patients with a history of alcohol use probability of single treatment was higher than that of double therapy in patients with acute and for the diagnosis of coronary heart disease, unstable angina and hyperlipidemia patients tend to use dual antiplatelet therapy, diagnosis of stable angina, ischemic stroke, peptic ulcer patients tend to use single antiplatelet therapy, interventional therapy patients tended to use dual antiplatelet therapy, bleeding tendency is the research object the main factors of single antiplatelet therapy in.4.2771 cases, the standardized application of antiplatelet therapy in patients with a total of 2305 cases, accounting for 83.2%; the patient is not standardized In 466 cases, accounting for 16.8%; had smoking history, diagnosed as coronary heart disease, patients with diabetes standardized application of antiplatelet drugs were better, 75 years of age, were treated for the diagnosis of peripheral atherosclerotic disease, anemia patients are often poor application of antiplatelet drug specification. Conclusion 1. in elderly patients with me hospital, antiplatelet drug application rate is high, but compared with the previous reported low, aspirin and chlorine PI Gray is the most widely used antiplatelet drug.2. in patients with coronary heart disease and ischemic cerebrovascular disease in aspirin alone and combined use rate was higher than that of chlorine PI Gray.3. acute coronary syndrome, acute PCI after operation. Ischemic cerebrovascular disease is the main factor of application of double antiplatelet therapy in patients with acute cardiovascular disease, dual antiplatelet drugs should be combined With acute ischemic cerebrovascular disease was higher than that of.4. in our hospital, elderly patients, 83.2% patients with standard antiplatelet drugs, but there are still 16.8% patients with antiplatelet drugs are not canonical.5. age, the coexistence of digestive system disease, interventional therapy of chronic kidney disease, hemorrhage, concerns are main influence factors in our hospital the standardized application of antiplatelet drugs in elderly patients.

【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R973

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