51例高龄急性心肌梗死死亡病例的临床分析

Retrospective analysis of fifty-one death cases of aged acute myocardial infarction

目的分析高龄急性心肌梗死(AMI)患者的住院死亡原因及相关危险因素。方法选择1999年1月～2003年12月住院年龄≥70岁的AMI患者459例,分为死亡病例组(51例)和非死亡病例组(408例)。对病史资料进行回顾性研究,比较两组临床特征,记录死亡原因,分析死亡高危因素。结果5年间年龄≥70岁AMI患者住院总病死率11.1%。死于心力衰竭15例(29.4%),心源性休克13例(25.5%),致死性心律失常-室颤8例(15.7%),心脏破裂6例(11.8%),肺部感染-呼吸衰竭6例(11.8%),急性肺栓塞和脑卒中3例(5.9%),其中31例(60.8%)死于入院48h内。死亡病例组前壁心梗、既往心梗、心衰和糖尿病史4项临床特征明显高于非死亡病例组,有统计学意义。结论高龄AMI患者死亡率高,死亡多发生于病程早期,心力衰竭、心源性休克和室颤是主要死因,前壁心梗、既往心梗、心衰和糖尿病史是死亡的重要危险因素。

Objective To analyze causes of death and risk factors in aged patients with acute myocardial infarction （ AMI）. Methods A total of 459 hospitalized aged patients（ ≥70 years old） with AMI were enrolled from January 1999 to December 2003. All patients were divided into death cases group（ n =51 ） and non-death cases group （ n =408）, retrospective study was conducted to analyze the causes of death and clinical characteristics. Results The mortality of hospitalized aged patients with AMI came to 11.1% ,causes leading to death were heart failure in 15 cases （29.4%） ,eardiogenie shock in 13 eases（25.5% ） , ventrieular fibrillation in 8 cases（ 15.7% ） ,rupture of the heart in 6 cases （ 11.8% ） ,lung infection and respiratory failure in 6 cases （ 11.8% ） ,acute pulmonary embolism and stroke in 3 cases （5.9%） respectively. 31 cases（60.8% ） died within 48 hours after hospitalization. The incidence in anterior wall myocardial infarction, history of myocardial infarction,heart failure and diabetes were significantly higher in death eases group than that in non-death eases group. Conclusion There is a high mortality in aged patients with AMI,common causes leading to death are heart failure, cardiogenie shock and ventricular fibrillation. Among all clinical characteristics, anterior wall myocardial infarction, history of myocardial infarction, heart failure and diabetes are important risk factors causing death in aged patients with AMI.