急性心肌梗塞急性期预后多因素分析──非条件Logistic模型

Multivariate Analysis on Prognostic Factorsfor Acute Myocardial Infarction during AcutePeriod Noncondition Stepwise Logistic Model

急性心肌梗塞是一常见的预后较严重的心血管疾病，急性期预后受多因素影响。本文用多因素非条件Ｌｏｇｉｓｔｉｃ模型分析报道了３１９例急性心肌梗塞，其中存活２６２例，死亡５７例。急性期病死率为１７．９％。年龄增大，预后越差，大于６０岁的病死率为２３．４％，高于６０岁以下的１２．８％。结果心衰、年龄、心律失常、肺内感染、心梗部位、高血压病史２０年以上，为急性期影响预后的主要因素。血清高密度脂蛋白对急性期死亡有保护作用。本文提出，挽救缺血的心肌，避免心衰是治疗急性心肌梗塞的根本措施。同时，控制肺内感染和恢复正常心律是一项必备的治疗措施。对患有高血压病史的人，应作为心肌梗塞的高危险人群，采取积极防治措施。

he relationship between baseline factorsdefined at 4.3±1.8 hr after onset of acute myo-cardial infarction and 28-day survival in 319 pa- tients admitted into the Chna Medical Univer- sity was evaluated.The case fatality rate duringacute period was 17.9%。Univariate statisticsidentified a significant relationship between5 of these factors and survival.Multivariatenoncondition stepwise logistic model analysisidentified four factors as being most closelyrelated to survival:(1)heart failure;(2)arrhythmia;(3)age;(4) history of essentialhypertension.It is concluded that heart failureduring the acute period of acute myocardialinfarction is the most important baseline factorfor prediction of 28-day survival.