老年急性心肌梗死心性死亡患者的临床特征

Clinical features of cardiac death in elderly patients with acute myocardial infarction

目的 对比分析老年急性心肌梗死心性死亡患者的临床表现、并发症、治疗与非老年患者的异同。方法 以 1993年 1月至 2 0 0 2年 12月因急性心肌梗死相继收住解放军总医院冠心病监护病房的 2 0 0例心性死亡患者为对象 ,≥ 6 5岁者 16 6例 (称老年组 ) ,<6 5岁者 34例 (称非老年组 ) ,比较两组的临床特征。结果 (1)两组冠心病、高血压病、饮酒史 (P <0 .0 1)、高血压病合并糖尿病史 (P <0 .0 5 )均有显著性差异 ;(2 )梗死前心绞痛及心肌梗死部位差异无显著性 ;(3)收缩压、脉压、左心室射血分数 ,有显著性差异 (P <0 .0 1或P <0 .0 0 1) ;(4)老年组应用阿斯匹林治疗者及应用血管紧张素转换酶抑制剂治疗比例高于非老年组 (分别为 5 4 %比 2 4 %P <0 .0 1及 32 %比12 %P <0 .0 5 ) ;(5 )老年组左室射血分数低于 5 0 %者多 (82 %比 5 5 % ,P <0 .0 5 ) ;死于急性肺水肿者高于非老年组 (2 9%比 15 % ,P <0 .0 5 ) ,死于心脏破裂者较非老年组少 (8%比 2 4 % ,P <0 .0 5 )。结论 老年急性心肌梗死心性死亡患者心血管合并症多 ,收缩压高 ,脉压差大 ,左心室射血分数低 ,并发症发生率高 ,死于急性肺水肿者多。因此 ,积极有效治疗 ,减少并发症 ,保护心功能是改善老年急性心肌梗死患者预后的重要环节。

Objective To determine the d if ferences in presentation, complications, management and outcome of cardiac death in patients with acute myocardial infarction (AMI) between the elderly and youn g patients. Methods The medical histories of all cases with de ath diagnosis of AMI from January 1 st, 1993 to June 30 th, 2002 in th e Chinese PLA General Hospital were reviewed retrospectively. The patients were divided into those aged 65 years or older (elderly,group A) and those younger t han 65 years (young,group B). Results Of the total p atients, 166 were at ages ≥65 years. Compared with 34 patients at age<65 years, the eld erly patients had a higher proportion of hypertension, coronary artery disease a nd hypertensive diabetes history (71% vs 44%, P<0.01, 69% vs 41%, P<0. 01, and 27% vs 9%, P<0.05, respectively) than the younger patients. There w as no statistically significant difference in prodromal angina pectoris and infa rct location between the two groups. The elderly patients had higher systolic bl ood pressure and pulse pressure (126±26 vs 110±25mmHg and 54±18 vs 41±12 mmH g, P<0.01, respectively) and lower left ventricle ejection fraction (38±8 vs 51±16, P<0.001). The elderly were more likely to receive aspirin or ang iotensin-converting enzyme inhibitors therapy (54% vs 24%, P<0.01, and 32% vs 12%, P<0.05, respectively). There were more patients complicated by acu te pulmonary edema and left ventricle ejection fraction <50% in the group A tha n in group B (29% vs 15%, P<0.01, 82% vs 55%, P<0.05, respectively). T he patients in group A had less ventricular rupture than those in group B (8% vs 24%, P<0.05). Conclusions The elderly patients who died of AMI had a higher proportion of hypertension, coronary artery disease and hypert ensive diabetes history and a lower left ventricle ejection fraction than the yo unger patients. There were more complications of acute pulmonary edema and low left ventricle ejection fraction and less ventricular rupture in the elderly pat ients with AMI than in the younger patients.