487例急性ST段抬高型心肌梗死死亡原因及处理对策分析

Analysis of the cause of death and treatment in 487 patients with ST-segment elevation acute myocardial infarction(STEMI)

目的:探讨急性ST段抬高心肌梗死主要的死亡原因及降低死亡率所应采取的对策。方法:对我院2005年1月～2009年1月收住的487例急性ST段抬高型心肌梗死,进行病例资料分析,及为期1年的随访,调查急性期及1年随访期间的死亡病例的死因及导致死亡的临床因素,包括年龄、梗死部位、所采取的再灌注治疗、并发症、左室功能、再缺血的评估及危险分层,并与同期存活的患者进行对照。结果:487例急性心肌梗死急性期死亡53例;急性期死亡的主要原因为:心脏的泵衰竭,心源性休克及机械并发症;1年随访新增死亡病例26例,主要死亡原因为泵衰竭;死亡病例与以下临床因素相关:广泛前壁心肌梗死,未进行再灌注治疗,梗塞后左室功能不全,反复发作的心肌缺血,心源性休克及机械并发症。结论:急注治疗通过危险分层、适时的介入干预可降低死亡率。

Objective：To evaluate the cause of death in STEMI patiets and to reduce the mortality rate.Methods：From January 2005 to January 2009,487 STEMI patients were involved in this study,The clinical factors of the death of STEMI patients were analyzed,Including age,areas of intervention,re-perfusion therapy,complation,left ventricnle function,the re-ischemic and risk factors.And compared with the survival patients in the same time.Results：There were 53 patients dead in early period and these patients were associated with some risk factors such as： extensive anteriorm cardial infarction,without re-perfusion therapy,post-infarectional heart failure,recurret myocardial ischemic,cardiogenic shock and mechanical complication.There were 26 new dead patinets in one-year fellow-up.The major reason of the death was heare failure of pose-myocardical infarction.Conclusion：Early re-ischemic and properly PCI threaphy may decrease the mortality of STEMI patients.