老年AECOPD患者合并急性心肌梗死临床观察

Clinical Analysis of Acute Myocardial Infarction in Elderly Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

目的探讨老年慢性阻塞性肺病急性加重期(AECOPD)合并急性心肌梗死(AMI)的临床特点,以减少误诊及漏诊。方法对老年AECOPD合并AMI(A组)22例患者的临床表现、实验室检查、心电图进行回顾性分析,与同期收治的单纯老年AECOPD(B组)164例患者进行比较。结果两组均有咳嗽、咳痰、气喘;A组突然出现胸闷、呼吸困难加重的发生率显著高于B组(100%比3.7%,P<0.01),多伴有冷汗(81.8%比0,P<0.01)、晕厥(22.7%比0,P<0.01)、消化道症状(36.4%比10.4%,P<0.01)和低血压(18.2%比3.7%,P<0.05);A组动脉氧分压/氧浓度(PaO2/FiO2)显著低于B组(313.52±126.68比361.86±120.82,P<0.05)。结论老年AECOPD患者突然出现胸闷和呼吸困难加重、冷汗、晕厥、低血压,应警惕合并AMI,追踪心电图及心肌酶谱动态变化有助诊断。

Objective To investigate the clinical characteristic of acute myocardial infarction（AMI） in elderly patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）. Method Clinical symptom,laboratory examination,electrocardiogram of 22 elderly patients with AECOPD and AMI （ Group A） were reviewed, Meanwhile, 164 elderly AECOPD patients without AMI （ Group B） were analyzed as control. Results Either Group A or Group B had cough ,expectoration,dyspnea;The incidence of the case of sudden ex- acerbation of chest tightness and dyspnea was significantly higher in Group A than in B（ 100% vs 3.7% ,P 〈0. 01 ） ,most of Group A ac- companying cold sweat（81.8% vs O,P 〈0. O1 ） ,syncope（22.7% vs 0,P 〈 0. 01 ） ,gastrointestinal symptoms（ 36.4% vs 10. 4% , P 〈 0. 01 ） and hypotension（ 18.2% vs 3.7%, P 〈 O. 05 ） ; the numerical of arterial partial pressure of oxygen/oxygen concentration （ PaO2/ FiO2 ） was significantly lower in Group A than in B（ 313.52 ~ 126.68 vs 361.86 ~ 120. 82 ,P 〈 0. 05 ）. Conclusion AMI should be aler- ted in the case of sudden exacerbation of chest tightness and dyspnea,cold sweat,syncope ,hypotension in elderly patients with AECOPD, Tracking electrocardiogram and myocardial zymogram may help to make a definite diagnosis.