摘要
目的探讨老年急性心肌梗死(AMI)患者近期转归的影响因素,为降低病死率提供理论依据。方法连续住院的305例首次AMI老年患者,男146例,女159例,对比分析其临床基础情况、梗死表现、治疗及临床经过、住院病死率及死亡原因,并对影响转归的变量进行多元回归分析。结果老年女性并存高血压和糖尿病的百分率较男性高(分别为56%对29%,33%对18%),男性吸烟者较女性多(40%对2%),差异均有显著性(均为P<0.01)。老年女性的心力衰竭、休克、机械并发症和住院病死率均高于男性(均为P<0.05)。然而,多元回归分析显示,性别并不是住院死亡的独立危险因子(OR,0.73;95%CI,0.25~2.23),而心功能Kilip分级(OR,6.82;95%CI,2.50~18.91)、机械并发症(OR,53.18;95%CI,11.56~401.30)、肌酸激酶(CPK)峰值(OR,1.69;95%CI,1.18~2.47)等可能有重要预后价值。结论老年AMI患者死亡危险性增加与心脏本身的危险因子有关,而性别无重要影响。
Objective To evaluate the factors,influencing the shortterm outcome of elderly patients with acute myocardial infarction (AMI). Methods The clinical history and evolution of 305 consecutive patients including 146 men and 159 women, ≥60 years of age, admitted with first AMI were compared. The inhospital mortality and the causes of death were analyzed. Multiple logistic regression analysis was performed among the variables correlated with adverse outcomes. Results Women had a higher prevalence of hypertension (56% versus 29%, P<001) and diabetes (33% versus 18%, P<001). Smokers were more in men (40% versus 2%, P<001). Women showed higher incidence of congestive heart failure, shock, mechanical complications and inhospital mortality (respectively, P<005). However, multiple logistic regression analysis excluded sex as an independent predictor of inhospital mortality (OR,073;95%CI,025223). Whereas. Killip class (OR,682;95%CI,2501891), mechanical complications (OR,5318;95%CI,115640130)and peak levels of CPK (OR,169;95%CI, 118247) were probably of important prognostic value. Conclusions The increase of mortality risk in the elderly after a first AMI seems to be related to the cardiac risk factor itself rather than to sex.
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
1998年第1期5-8,共4页
Chinese Journal of Geriatrics