急性心肌梗塞住院病死率及其影响因素的10年对比研究

A Comparative Study on Hospital Mortality and Its Influencing Factors of Acute Myocardial Infarction During Ten Years

研究该院１０年间收治的急性心肌梗塞（ＡＭＩ）患者的住院病死率及其影响因素。对１９８７～１９９７年间冠心病监护病房收治的８１２例ＡＭＩ患者分成１９９２年前后两组进行回顾性分析。结果显示，①住院病死率从１３．０８％下降到８．７６％（Ｐ＜０．０５）；②静脉尿激酶溶栓率从１１．７１％上升到２３．６０％（Ｐ＜０．００１），且梗塞相关血管再通率由３７．２０％（１０／４３）上升至５７．１４％（５９／１０５）（Ｐ＜０．０５）；③ＡＭＩ合并症明显降低，尤以泵衰竭最显著（１９．１０％比２８．６１％，Ｐ＜０．０１），其次为室颤和室速（ＶＦ／ＶＴ）（１８．８８％比２４．８０％，Ｐ＜０．０５）；④近５年ＡＭＩ发病年龄呈下降趋势〔平均年龄自（６３．９２±１０．０２）岁下降到（６１．６０±９．３７）岁Ｐ＜０．０１）；⑤ＡＭＩ发病前的既往病史中糖尿病（ＤＭ）有上升趋势（８．７２％比１３．４８％，Ｐ＜０．０５），其次为高血脂症（１１．４４％比１６．８５％，Ｐ＜０．０５），心肌再梗塞发生率近５年由９．２６％上升至１５．０６％（Ｐ＜０．０５）。可见，１０年间ＡＭＩ治疗有较大的进展，使ＡＭＩ住院病死率明显下降，ＡＭＩ合并症降低。但应注意近５年ＡＭ?

To assess death rate and its effect factors of acute myocardial infarction(AMI) during 1987～1997,before and after 1992 of all patients consecution admitted to the coronary care unit(CCU)at our hospital with a diagnosis of AMI,during 1992 to 1997,812 were enrolled in a study comparing the clinical therapeutic and mortality.The results showed:①Hospital mortality was significantly decreased(13 08% vs 8 76%, P <0 05).②Intravenous thrombolytic rate was significantly increased(11 71% vs 23 60%, P <0 001).The reperfusion rate of infarct related artery(IRA) from 37 20% elevated to 57 14%( P <0 05).③Complication of AMI was significantly reduced,left ventricular failure from 28 61% reduced to 19 10%( P <0 01);ventricular arrhythmias(VF/VT) from 24 80% reduced to 18 88%( P <0 05).④The age of invasion was significantly reduced mean age(63 92±10 02)years vs(61 60±9 37)years, P <0 01 .⑤Patients by treated differed in medical history;diabetes mellitus from 8 72% elevated to 13 48%( P <0 05);hyperlipoidemia from 11 44% elevated to 16 85%( P <0 05);re infarction rate from 9 26% elevated to 15 06%.This study shows that recent years,hospital mortality was significantly reduced,it is almost entirely depend on using intravenous thrombolysis therapy and elevating the reperfusion rate of IRA.Nevertheless,it suggested recent years that because the dietary as well as life modification was changing,age of AMI was reduced and in medical history of patients with AMI,diabetes mellitus and hyperlipoidemia was significantly elevated.