老年非ST段抬高心肌梗死临床特点及院内死亡因素分析

Clinical characteristics and risk factors of in-hospital death of elderly patients with non-ST-segment elevation myocardial infarction

目的评价老年非ST段抬高心肌梗死(NSTEMI)患者的临床特点、院内死亡的相关因素并总结院内死亡病例的临床特征。方法选择自2001年1月至2008年4月NSTEMI住院病例428例,分为老年组和非老年组,其中死亡病例32例。回顾性地分析其临床资料并评价院内死亡相关因素。结果老年NSTEMI有糖尿病史、心绞痛史、心肌梗死史、肾功能不全史及症状不典型者均多于非老年组,入院时心功能KillipⅢ～Ⅳ级多,住院期间接受冠脉造影者较非老年组少,差异均有统计学意义;死亡组的年龄明显高于存活组〔(76.22±5.02)岁vs(68.89±11.9)岁,P<0.01〕,肺感染为死亡组最常见的发病诱因(占37.5%)和合并症(占56.2%);Logistic分析显示,年龄(OR1.095)及入院时心功能高Killip分级(OR3.418)、心率(OR1.073)、血白细胞计数(OR 1.213)、血糖水平(OR1.399)是老年NSTEMI患者住院期间死亡的独立预测因素。结论老年NSTEMI患者糖尿病史、心绞痛史、心肌梗死史、肾功能不全史及症状不典型者多见,住院期间接受冠脉造影者少;死亡组的年龄明显高于存活组,肺感染为死亡组最常见的发病诱因和合并症;年龄及入院时心功能高Killip分级、心率、血白细胞计数、血糖水平是老年NSTEMI患者住院期间死亡的独立预测因素。

Objective To evaluate the retrospective features of elderly patients with non-ST-segment elevation myocardial infarction （NSTEMI）, investigate correlation factors for in-hospital death and summarize clinical characteristics of deceased patients in hospital. Methods A total of 428 patients presenting with NSTEMI between Jan 2001 to Apr 2008 were included. Patients were divided into elderly group（≤65 years,n=302） and non-elderly group （〈65 years,n= 126）, 32 patients deceased in hospital. Their clinical data were analyzed retrospectively, and correla- tion factors for in-hospital death were evaluated. Results Patients of elderly group were more likely to have history of diabetes mellitus, angina, myocardial infarction, renal function and atypic symptoms compared with non-elderly group,more likely to be with heart function of Killip grades Ⅲ-Ⅳ ,and less experienced angiography,P〈0.05 for all the above parameters;the age of death group was higher than alive group[（76. 221 5.02） years vs （68.89± 11.9） years, P〈0. 01], pulmonary infection was the most frequent cause （37.5 %） and complication（56.2%） in the death group;multifactorial logistic regression analysis showed that age（OR 1. 095） and Killip grades Ⅲ-Ⅳ （OR 3. 418）, heart rate（OR 1. 073）, white blood cell count of peripheral blood（OR 1. 213） and level of blood glucose （OR 1. 399） on admission have independently correlated with the in hospital death. Conclusion Patients of elderly group are more likely to have history of diabetes mellitus, angina, myocardial infarction, renal function and atypic symptoms compared with non-elderly group,and they are less experienced angiography; the age of death group is more likely to be higher than alive group, pulmonary infection is the most frequent cause and complication in the death group; age and Killip grades Ⅲ-Ⅳ, heart rate, white blood cell count of peripheral blood, level of blood glucose on admission may be the independent risk factors of in-hospital death of patients with NSTEMI.