老年急性心肌梗死患者溶栓疗效及安全性

The efficacy and safety of thrombolytic therapy in elderly cases of acute myocardial infarction

目的 探讨老年急性心肌梗死 (AMI)患者接受静脉溶栓治疗的疗效及安全性。方法 回顾分析 3年内收治的AMI 643例中 30 2例接受静脉溶栓治疗的临床疗效。结果 1 94例老年 (≥ 60岁 )组与 1 0 8例非老年组之间比较 ,其梗死相关血管 (IRA)再通率 (67.0 % ,73 .1 % )和出血及并发症率 (7.7% ,5 .65 % )均差异无显著性意义 (P >0 .0 5) ;所有接受溶栓治疗的AMI患者比不溶栓者的病死率 (7 0 % ,1 4 .7% )、中度以上心力衰竭发生率 (1 7.5 % ,30 .5 % )等明显减低 (P <0 .0 1 ) ;高龄 (≥ 80岁 )AMI2 9例中 ,8例溶栓者比不溶栓者的病死率低 1 6 .1 % ,中度以上心力衰竭低 32 .1 %。结论 AMI溶栓治疗在不同年龄组均安全、有效 。

Objective To investigate the efficacy and safety in elderly patients with acute myocardial infarction(AMI) who received thrombolytic therapy. Methods Six hundred and forty three AMI cases hospitalized on our CCU wards during 3 years were selected and analyzed. Of them 302 cases underwent intravenous thrombolytic therapy. Results There were no significant differences in the reperfusive rate (67.0% vs 73.1%) of infarct related artery and hemorrhage incidence (7.7% vs 5.65%) between 194 elderly cases ( ≥60yr ) and 108 non elderly cases (P>0.05);The mortality (7% vs 14.7%) and the rate of ≥Killip Ⅱ heart failure (17.5% vs 30.5%, P<0.01) were lower in cases treated with thrombolysis than without;In 29 very elderly patients (≥80yr.), 8 underwent thrombolytic therapy and their mortality was reduced by 16.1% and the rate of ≥Killip Ⅱ heart failure decreased by 32.1%, though the difference was not significant owing to small samples. Conclusion It is effective and safe to treat aged cases of AMI with thrombolytic therapy, and the very elderly seem to be benefited more from the therapy.