青年人急性心肌梗死的临床特征和急诊溶栓治疗

Clinical Features and Emergent Thrombolytic Therapy of Acute Myocardial Infarction in Young Patients

目的探讨青年人和老年人急性心肌梗死的临床特征和药物静脉溶栓疗效。方法24例年龄≤45岁的年轻急性心肌梗死患者进行药物溶栓治疗，同时连续选取40例50—70岁行溶栓治疗的急性心肌梗死患者作为对照组。观察患者的临床病史、风险因素（吸烟史、高胆固醇血症、高血压、糖尿病、冠心病家族史）以及溶栓效果等。结果青年组男性患者比例高于对照组（P〈0．01）；青年组有吸烟史者79．2％，家族史者45．8％，均高于对照组（分别为40．0％和12．5％，P〈0．01）；而对照组高血压和糖尿病比例较青年组高（60．0％和40．0％比16．7％和12．5％，P〈0．05）。青年组心绞痛病史明显短于对照组（324±576天比928±1846天，P〈0．001），胸痛时间〈30天及〈12h者明显高于对照组（62．5％和41．7％比10．0％和5．0％，P〈0．001）。两组溶栓开始时间无显著性差异，但青年组冠状动脉再通率明显高于对照组（75．0％比50．0％P〈0．05）。结论吸烟和家族史是青年人急性心肌梗死的主要危险因素；青年人临床病史短，动脉硬化程度轻，药物静脉溶栓效果优于老年患者。

Aim To investigate the clinical features and therapeutic efficacy of thrombolytic therapy of acute myocardial infarction （AMI） in young patients and older patients. Methods 24 patients ≤〈45 years of age with a diagnosis of AMI, were received thrombolytic therapy after the onset of AMI, and assigned to the young group. 40 consecutive patients aged 50 - 70 years old were selected as the control group. The patient＇ s cardiovascular history, risk factors （ smoking, hypercholesterolemia, hypertension, diabetes mellitus, and family history） and therapeutic efficacy of thrombolytic therapy were recorded and analysed. Results The percentage of male in young group were higher than in older group （ P 〈 0.01 ）. The percentage of smoking and family history in young group were higher than in older group （ 79.2% and 45.8% vs 40.0% and 12.5%, P 〈 0.01 ）. The percentage of hypertension and diabetes mellitus in older group were higher than in young group （60.0% and40.0% vs16.7% and12.5%,P〈0.05 ）. The history of angina pectoris in young group were shorter than in older group （324 ±576 days vs 928±1 846 days, P 〈 0.001 ）. The patients of chest pain in 30 days and 12 hours in young group were much more than in older group （ 62.5% and 41.7% vs 10.0% and 5.0%, P 〈 0. 001 ）. The initiating time of reperfusion had no significant difference in two groups, but the recanalization rate of coronary artery was higher in young group than in older group （75.0% vs 50.0%, P 〈 0.05 ）. Conclusion Smoking and family history were the most common risk factors among young patients. The clinical history of young patients was shorter than older patients. The therapeutic efficacy of thrombolytic therapy in young patients was more excellent than in older patients.