老年人2型糖尿病患者无胸痛性急性心肌梗死临床观察

Observation on clinical characteristics of the elderly type 2 diabetes mellitus patients with acute myocardial infarction presenting without chest pain

目的 观察老年2型糖尿病患者无胸痛性心肌梗死的临床特点.方法 临床确诊的60岁以上老年人2型糖尿病无胸痛性心肌梗死患者作为观察组（A组,41例）,老年2型糖尿病心肌梗死伴典型心绞痛患者（B组,49例）及非老年人2型糖尿病心肌梗死伴典型心绞痛患者作为对照组（C组,43例）.比较3组基线临床资料,发作至入院时间、急性心肌梗死发作时的主要临床表现、合并症、并发症、心电图特点,并比较院内病死率.结果 3组临床基线资料比较显示,A组较B、C组患者年龄大[（74±9）岁],糖尿病病程长[（18±5）年],合并疾病比例高,发作至入院诊时间长[（19±13）h]（均为P＜0.05）.C组男性较A、B组多（88.4%）,A、B组间差异无统计学意义（均为P＜0.05）.A组以呼吸困难、恶心呕吐、乏力、头晕为主要临床表现,室性心律失常较多见（34.1%）.ECG表现为ST段抬高型心肌梗死较少（31.7%）非ST段抬高型心肌梗死较多（48.8%）,梗死部位为下壁（36.6%）和后壁（26.8%）较多.A组病死率为17.1%,B组为8.1%,C组为7.O%.A组病死率较B、C组高,有统计学意义（均为P＜0.05）.结论 老年人2型糖尿病无胸痛性心肌梗死患者年龄较大,糖尿病病程较长,合并疾病较多,临床症状多变,ECG表现为STEMI较少NSTEMI较多,梗死部位为下壁和后壁较多,病死率较高,临床应提高对其的认识.

Objective To observe the clinical characteristics of the elderly type 2 diabetes meUitus （2-DM） patients with acute myocardial infarction（AMI） presenting without chest pain. Methods The patients were divided into 3 groups, including elderly 2-DM patients with AMI presenting without chest pain （group A, 41 cases）, elderly 2-DM patients with AMI presenting with chest pain （group B ,49 cases）, and non-elderly 2-DM patients with AMI presenting with chest pain（ group C, 43 cases）. The basic clinical data, clinical characteristics, and mortality among the 3 groups were compared. Results The basic data showed that patients in group A were more likely to be older [ （ 74 ± 9 ） years ], had longer DM duration[ （18 Myocardial infarction, acute; Aged; Diabetes mellitus,type 2 5 ）years ], more co-morbid conditions, more likely to complain of dyspnea, nausea, vomiting, tired, dizziness. ECG showed more ventrieular arrhythmias, and more non-ST-elevation MI. Infarction located most in inferior, the mortality in group A （17.1% ） was higher than in group B （8.1%） and C （7.0%）. Conclusions Our results suggest that elderly 2-DM patients with myocardial infarction presenting without chest pain are older, have longer DM duration, more co-morbid conditions, complicated syndromes, and the mortality is higher. Health care providers need to have an increased awareness of possible presence of AMI in elderly persons with diabetes when evaluating patients with no chest pain.