急性心肌梗死患者入院时心率水平与死亡率相关性分析

The Relationship Between the Heart Rate on Admission and Mortality of Patients with Acute Myocardial Infarction

目的:观察急性心肌梗死(AMI)患者入院时心率水平与住院期间死亡率的关系。方法:2003～2008年在我院住院的ST段抬高AMI患者156例,根据入院时心率分为心率<80次/min组、心率80～90次/min组及心率>90次/min组,分别记录左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室射血分数(LVEF)及住院期间的死亡例数。结果:心率>90次/min组及心率80～90次/min组患者前、侧壁心肌梗死发生率均高于心率<80次/min组(P均<0.05)。心率>90次/min组和心率80～90次/min组患者LVEDD均高于心率<80次/min组;心率>90次/min组的LVESD明显高于心率80～90次/min组及心率<80次/min组;而心率>90次/min组LVEF明显低于心率80～90次/min组及<80次/min组。156例患者住院期间死亡15例(9.6%)。心率>90次/min组死亡率20%(5/25),明显高于心率80～90次/min组的12.5%(P<0.05)和心率<80次/min组的6.1%(P<0.01)。结论:入院时心率增快是AMI患者住院期间发生死亡的强预测因子。

Objective： To discuss the relationship between the heart rate （HR） on admission and mortality of acute myocardiol infarction （AMI） patients. Methods： A total of 156 AMI patients with ST segment elevation treated at our hospital from 2003 to 2008 were studied. According to the HR on admission, they were assigned to less than 80 heartbeats per minute group, 80- to- 90 group, and more than 90 group. Left ventricular end- diastolic diameter（ LVEDD）, left ventricular end - systolic diameter（ LVESD）, left ventricular ejection fraction （LVEF） and death number during admission were measured and recorded. Results： No difference was found in age, gender, history of smoking, hypertension and diabetes among the 3 groups（ P 〉 0.05）. Incidence of anterior and lateral myocardial infarction in the more than 90 and 80 - to - 90 heartbeats groups was higher than that in the less than 80 heartbeats group （P 〈 0.05）. The Patients in the less than 80 heartbeats group had shorter LVEDD compared to the other 2 groups. The more than 90 heartbeats group had longer LVESD but lower LVEF compared to the other 2 groups. The overall mortality was 9.6% （15/156）. The mortality was 20% （5/25） in the more than 90 heartbeats group, which was much higher than the 12.5 % （P 〈 0.05） in the 80 -to -90 group and 6.1% （ P 〈 0.01 ） in the less than 80 group. Conclusion ： The increased HR on admission is a predictive factor for the death of AMI patients during admission.