院内发生器官功能衰竭对老年急性心肌梗死患者预后的影响——附2535例病例分析

Influence of in-hospital occurrence of organ failure on the prognosis of acute myocardial infarction in the elderly patients： an analysis of 2 535 cases

目的比较不同年龄老年急性心肌梗死（AMI）患者住院发生心、肺、肾器官功能衰竭等严重并发症情况及其对近期预后的影响。方法对2535例老年AMI住院患者按年龄、住院期间预后分别分组，回顾分析各组并发症的发生率。结果①与60～79岁组（老年组）AMI患者相比，≥80岁组（高龄组）住院病死率显著升高[22．75％（326／422）比12．26％（1854／2113），χ2=42．15，P〈0．013。②老年死亡组（259例）并发心源性休克（44．0％）、心功能KillpⅡ～Ⅲ级（28．2％）、呼吸衰竭（14．3%）、脑卒中（11．2％）、肾衰竭（11．2％）、心律失常（49．8％）、贫血（14．7％）的发生率均高于存活组（1854例，分别为27．1％、17．4％、7．5％、4．5％、4．5％、40．3％、9．1％，均P〈0．01）；两组间消化道出血（5．8％比3．9％）和肺感染（24．7％比20．2％）发生率差异无统计学意义（均P〉0．05）。高龄死亡组（96例）并发心源性休克（28．10．4）、心功能KillpⅡ～Ⅲ级（32．3％）、呼吸衰竭（17．7％）、肾衰竭（16．7％）、消化道出血（10．4％）、心律失常（49．0％）、贫血（21．9％）的发生率均高于存活组（326例，分别为12．9％、21．2％、9．2％、5．2％、2．1％、35．0％、10．1％，P〈0．05或P〈0．01）；两组间脑卒中（11．4％比5．8％）和肺感染（32．3％比23．3％）发生率差异均无统计学意义（均P〉0．05）。⑧老年死亡组和存活组患者住院并发症种类前4位均为心律失常、心源性休克、心功能KillpⅡ～Ⅲ级、肺感染；而高龄死亡组和存活组患者住院并发症种类前4位依次为心律失常、肺感染、心功能KillpⅡ～Ⅲ级、心源性休克。高龄死亡组患者住院期间心源性休克发生率低于老年死亡组（28．1％比44．0％，P〈0．01），但猝死率显著高于老年死亡组（22．92％比7．34％，P〈0．01）。结论高龄AMI患者住院病死率升高，器官功能衰竭发生率明显增多；其中心律失常是老年和高龄AMI患者首要的并发症。对于老年患者，应高度重视心源性休克的发生和救治，而对于高龄AMI患者，更需警惕和预防猝死的发生。

Objective To investigate the influence of in-hospital occurrence of organ failure on the prognosis of acute myocardial infarction （AMI） in 2 535 elderly patients of different age. Methods A total of 2 535 patients with AMI were divided into different age groups or outcome groups, and the outcome or the incidence of in-hospital complications were reviewed in different groups. Results ①The rate of in-hospital death was higher in ≥80 years group （22.75%, 326/422） compared with that in 60 79 years group （12.26%, 1 854/2 113, χ2=42-15, P〈0.01）. ②Compared with the survivors （1 854 cases, 27.1%, 17.4%, 7.5%, 4.5%, 4. 5%, 40.3%, 9.1%）, patients who died in hospital （259 cases） were more likely to have cardiogenic shock （44.0%）, Killp Ⅱ -Ⅲ heart function （28.2%）, respiratory failure （14.3%）, stroke （11.2%）, renal failure （11.2%）, cardiac arrhythmia （49.8%）, and anemia （14.7%） in 60 -79 years group （all P（0.01）. No difference in the rate of pulmonary infection （24.7% vs. 20. 2%） and alimentary tract hemorrhage （5.8% vs. 3.9%） was found between two groups （both P〈0.05）. The incidence of cardiogenic shock （28.1%）, Killp Ⅱ -Ⅲ heart function （32.3%）, respiratory failure （17.7%）, renal failure （16.7%）, alimentary tract hemorrhage （10.4%）, cardiac arrhythmia （49.0%） and anemia （21.9%） was higher in non-survival group （96 cases） than that in survival group （326 cases, 12.9%, 21.2%, 9.2%, 5.2%, 2.1%, 35.0%, 10. 1%, P〈0.05 or P〈0. 01） in patients≥80 years. There was no difference in the incidence of stroke （11.4% vs. 5.8%） and pulmonary infection （32.3% vs. 23.3%） between two groups （both P〉0. 05）. ③ The foremost four in-hospital complications in the non-survivors and survivors were cardiac arrhythmia, cardiogenic shock, Killp Ⅱ -Ⅲ heart function and pulmonary infection in 60 - 79 years group, hut they were cardiac arrhythmia, pulmonary infection, Killp Ⅱ-Ⅲ heart function and cardiogenic shock in ≥80 years group. When compared the cases of in-hospital death between these two different age groups, the incidence of cardiogenic shock was significantly lower in the ≥80 years group （28.1% vs. 44.0%, P（0. 01）. However, the incidence of sudden death was higher in the ~80 years group than that in 60 - 79 years group （22.92% vs. 7.34%, P〈0. 01）. Conclusion The number and degree of in-hospital complications in elderly patients with AMI are increased by age. Cardiac arrhythmia is the major complication in elderly patients. For the patients 60-79 years old, it is more important to prevent and treat cardiogenic shock in order to improve the outcome in the 60-70 years group. In very old people with AMI, it is important to prevent sudden death.