影响急性心肌梗死患者住院病死率的因素

Factors affecting in-hospital mortality in patients with acute myocardial infarction

目的探讨影响急性心肌梗死(AMI)患者住院病死率的因素。方法回顾分析AMI患者2 136例,比较出院时存活和住院期间死亡两组患者的临床特征和住院治疗,并应用Logistic回归分析筛选影响AMI患者住院病死率的因素。结果与存活组相比,死亡组患者年龄较大[(71±10)岁vs(62±11)岁,P<0.01],男性和有吸烟史者较少(56.0%vs71.5%,P<0.01;45.2%vs54.2%,P<0.05),高血压病、糖尿病和高脂血症患病率较高(分别为58.3%vs43.2%,47.7%vs21.1%,72.0%vs58.8%,均P<0.01),心功能Killip分级较高(2.0±1.1vs1.2±0.5,P<0.01),急性期再灌注治疗率和住院期间β受体阻滞剂及硝酸酯类药物的使用率较低(分别为10.1%vs30.3%,47.0%vs71.1%,95.2%vs98.6%,均P<0.01)。Logistic回归分析显示年龄、高血压病、糖尿病、高脂血症、心功能Killip分级、再灌注治疗、β受体阻滞剂和硝酸酯类药物的使用率为影响AMI患者住院病死率的独立危险因素。结论年龄、高血压病、糖尿病、高脂血症、心功能Killip分级、再灌注治疗、β受体阻滞剂和硝酸酯类药物的使用率对AMI患者住院病死率有显著影响。

AIM To investigate factors affecting in-hospital mortality in patients with acute myocardial infarction （AMI）. METHODS A retrospective study was conducted in 2 136 patients with AMI, whose baseline characteristics and therapeutic approaches during hospital stay were compared between the survivors （ 1 968） and the dead （168）. To identify the significant factors predictive of in-hospital death, multivariate logistic regression analysis was performed. RESULTS Compared with those of the survivors, the dead were substantially older [ （71 ± 10） vs （62 ±11 ） years, P 〈0. 01 ], had a higher prevalence of hypertensive disease, diabetes mellitus and hyperlipidemia （58.3% vs 43.2%, 47.7% vs 21.1%, 72. 0% vs 58. 8%, respectively, all P 〈0. 01 ）, less related to cigarette smoking （45.2% vs 54. 2% ,P 〈0. 05）, but had a higher Killip class of cardiac function on admission （2. 0 ± 1.1 vs 1.2 ±0. 5, P 〈 0. 01 ）. Compared with those of the survivors, reperfusion therapy within the first 12 hours after symptom onset and the use of beta receptor blockers and nitrates were lower during hospitalization phase in the dead patients （10. 1% vs 30. 3% ,47.0% vs 71.1% ,95.2% vs 98.6%, respectively, all P 〈0. 01 ）. The results of logistic regression demonstrated that age, diabetes mellitus, hypertensive disease, Killip classification of cardiac function, reperfusion therapy, and uses of beta receptor blockers and nitrates were significant factors affecting in-hospital death in patients with AMI. CONCLUSION Age, diabetes mellitus, hypertensive disease, Killip classification of cardiac function, reperfusion therapy and uses of beta receptor blockers and nitrates are the significant factors affecting in-hospital death in patients with AMI.