不同治疗方法对老年急性心肌梗死的疗效分析

Analysis of efficacy of different therapies in treatment of elderly patients with acute myocardial infarction

目的探讨不同治疗方法对老年急性心肌梗死的疗效和安全性。方法选择老年ST段抬高急性心肌梗死患者483例,根据不同治疗方法分为常规治疗组(A组,73例)、溶栓治疗组(B组,182例)和急诊PCI组(C组,228例)。回顾性对比分析患者的血管再通率、住院时间和不良心血管事件的发生率。结果与A组比较,B组和C组患者平均住院时间明显缩短(P<0.05),血管再通率明显升高(P<0.05);而C组血管再通率明显高于B组(P<0.05);与A组和B组比较,C组患者心肌梗死后心绞痛、再梗死、严重心律失常、中度以上心力衰竭,心源性休克以及随访第30天病死率均明显降低,差异有统计学意义(P<0.05)。B组皮肤黏膜出血和严重颅内出血明显高于A组和C组患者,差异有统计学意义(P<0.05)。结论老年急性心肌梗死行急诊PCI优于溶栓治疗和常规治疗。

Objective To investigate the efficacy and safety of different therapies in treatment of acute myocardial infarction（AMI） in elderly patients. Methods The clinical data of the elderly patients with AMI treated with routine method（73 cases）, thrombolytic（182 cases）and emergency percutaneous coronary intervention（PCI,228 cases） were retrospectively analyzed. The length of hospital stay,rates of recanalization and major adverse events among them were studied. Results The length of hospital stay in emergency PCI and thrombolytic groups was shorter than that in routine group. The recanalization rate in routine group was lower than that in emergency PCI and thrombolytic groups. The incidence of post-infarction angina in routine and thrombolytic groups was higher than that in emergency PCI group. The rate of re-infarction in emergency PCI and routine groups was lower than that in thrombolytic group. After emergency PCI, the incidences of heart failure, severe arrhythmia, cardiogenic shock and mortality on 30th day of follow-up were decreased remarkably. The incidences of skin and digestive system hemorrhage in thrombolytic group were higher than those in emergency PCI and routine groups. The incidence of cerebral hemorrhage in thrombolytic group was higher than that in routine and emergency PCI groups. Conclusion The emergency PCI in elderly patients with AMI was effective and safe,and is superior to routine and thrombolytic treatment.