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首页> 外文期刊>The journals of gerontology.Series A. Biological sciences and medical sciences >Treatment of unstable angina pectorison-ST-segment elevation myocardial infarction in elderly patients.
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Treatment of unstable angina pectorison-ST-segment elevation myocardial infarction in elderly patients.

机译：老年患者不稳定型心绞痛/非ST段抬高型心肌梗死的治疗。

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Elderly patients with unstable angina pectorison-ST-segment elevation myocardial infarction should be hospitalized. Precipitating factors should be identified and corrected. Electrocardiogram monitoring is important. Aspirin should be given as soon as possible and continued indefinitely. Clopidogrel should given for up to 9 months in patients in whom an early noninterventional approach is planned or in whom a percutaneous coronary intervention (PCI) is planned. Clopidogrel should be withheld for 5-7 days in patients in whom elective coronary artery bypass graft surgery (CABGS) is planned. A platelet glycoprotein IIb/IIIa inhibitor should also be given in addition to aspirin, clopidogrel, and heparin in patients in whom cardiac catheterization and PCI are planned. Patients whose symptoms are not fully relieved with three 0.4-mg sublingual nitroglycerin tablets or spray taken 5 minutes apart and the initiation of an intravenous beta blocker should be treated with continuous intravenous nitroglycerin. Beta blockers and angiotensin-converting enzyme (ACE) inhibitors should be given and continued indefinitely. The benefit of long-acting nondihydropyridine calcium channel blockers is limited to symptom control. Intra-aortic balloon pump counterpulsation should be used for severe ischemia that is continuing or occurs frequently despite intensive medical therapy or for hemodynamic instability. Statins should be used if the serum low-density lipoprotein (LDL) cholesterol is >or=100 mg/dl and continued indefinitely. Enoxaparin is preferable to intravenous unfractionated heparin in the absence of renal failure and unless CABGS is planned within 24 hours. Thrombolysis is not beneficial. High-risk patients should have an early invasive strategy with CABGS or PCI performed depending on the coronary artery anatomy, left ventricular function, presence or absence of diabetes, and findings on noninvasive testing. Following hospital discharge, patients should have intensive risk factor modification with cessation of smoking, maintenance of blood pressure below 135/85 mmHg, indefinite use of statins if needed to maintain the serum LDL cholesterol <100 mg/dl, intensive control of diabetes, maintenance of optimal weight, and daily exercise. Patients should be treated indefinitely with aspirin, beta blockers, and ACE inhibitors and with clopidogrel for up to 9 months. Nitrates should be given for ischemic symptoms. Hormonal therapy should not be given to postmenopausal women.
机译：患有不稳定型心绞痛/非ST段抬高型心肌梗塞的老年患者应住院治疗。应识别并纠正诱发因素。心电图监测很重要。应尽快服用阿司匹林，并无限期服用。计划采用早期非介入治疗或计划进行经皮冠状动脉介入治疗（PCI）的患者，应给予氯吡格雷长达9个月的治疗。计划进行择期冠状动脉搭桥术（CABGS）的患者应停用氯吡格雷5-7天。对于计划进行心脏导管和PCI的患者，除阿司匹林，氯吡格雷和肝素外，还应给予血小板糖蛋白IIb / IIIa抑制剂。如果患者的症状不能通过三片0.4毫克的舌下硝酸甘油片剂或喷雾剂分开5分钟而完全缓解，并且开始使用静脉内β受体阻滞剂，则应连续使用硝酸硝酸甘油治疗。应给予β受体阻滞剂和血管紧张素转化酶（ACE）抑制剂，并无限期继续使用。长效非二氢吡啶钙通道阻滞剂的益处仅限于症状控制。主动脉内球囊反搏应用于严重的局部缺血，这种持续的局部缺血即使经过深层药物治疗仍持续发生或频繁发生，或用于血流动力学不稳定。如果血清低密度脂蛋白（LDL）胆固醇大于或等于100 mg / dl并无限期持续，则应使用他汀类药物。在没有肾功能衰竭的情况下，依诺肝素比静脉普通肝素更可取，除非计划在24小时内计划使用CABGS。溶栓是无益的。高危患者应根据冠状动脉解剖结构，左心室功能，是否存在糖尿病以及无创检查的结果，采取CABGS或PCI的早期侵入性策略。出院后，患者应进行严格的危险因素调整，包括戒烟，将血压维持在135/85 mmHg以下，如果需要维持血浆LDL胆固醇<100 mg / dl则无限期使用他汀类药物，加强对糖尿病的控制，维持最佳体重和日常锻炼。患者应无限期接受阿司匹林，β受体阻滞剂和ACE抑制剂以及氯吡格雷治疗长达9个月。硝酸盐应给予缺血症状。绝经后妇女不应进行激素治疗。

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