高龄急性心肌梗死患者院内死亡的临床因素分析

Clinical risk factors of in-hospital died in elderly patients with acute myocardial infarction

目的评价日常临床实践中高龄急性心肌梗死（AMI）住院病人的近期预后和死亡的相关因素及死亡原因。方法研究包括167例年龄≥75岁AMI患者，按是否发生住院期间死亡分成：死亡组54例。存活组113例。回顾性分析其临床特征与死亡之间的关系和死因。结果与存活组比较。死亡组的年龄、入院时心率、外周血白细胞计数、血糖、血尿素氮值均明显高于存活组，而左室射血分数值却显著低于存活组；发病症状不典型、既往脑血管病史、肾功能不全病史、入院时Killip心功能分级Ⅲ～Ⅳ级、并发肾功能不全或其他并发症者多于存活组。而接受冠脉造影的病人比例明显少于存活组。多因素Logistic分析显示：入院时高Killip心功能分级（OR9．53，P〈0．01）、并发脑血管病（OR8．43，P=0．04）、既往脑血管病史（OR4．10，P=0．02）、入院时血糖水平（OR1．10，P=0．02）和心率（OR1．03，P=0．04）、典型症状发病（OR0．24，P=0．01）是高龄AMI患者住院期间死亡的独立预测因素。死亡患者中66．67％死于心力衰竭。结论高龄AMI患者有很高的住院死亡率，主要死亡原因为心力衰竭；入院时心功能状态、既往或并发脑血管病、心力衰竭和发病时症状表现是高龄AMI患者住院期间死亡的独立相关因素。

Objective To evaluate the relationship between clinical risk factors and in-hospital mortality, and the causes of death in elderly acute myocardial infarction（AMI） patients. Methods A total of 167 consecutive patients aged ≥75 years with AMI were included. According to in-hospital death, the patients were divided into death group （n= 54） and alive group （n= 113） . The relationship between clinical characteristics and causes of in-hospital death were analyzed. Results Compared with alive group, the age, heart rate on admission, peripheral blood WBC count, blood glucose and BUN value were higher in death group, while left ventricular ejection fraction was lower. The symptoms were atypical, past history of cerebrovascular disease and renal insufficiency, Killip grades 3-4 on admission and the complications such as renal failure were more frequent in death group than in alive group, but coronary angiography was not used routinely in death group. Multifactorial logistic regression analysis showed that Killip grades 3-4, complication of cerebrovascular disease, history of cerebrovascular disease, typical symptoms, heart rate and level of blood glucose on admission were the independent predictive factors of in-hospital death in elderly patients with AMI. up to 66. 67% of died patients succumbed to heart failure. Conclusion The elderly AMI patients had high mortality in hospital, most of death were caused by heart failure. The status of heart function on admission, history or complication of cerebrovascular diseases, heart failure, and the typical symptom of AMI have independent correlations with the in-hospital death in elderly patients with AMI.