老年急性心肌梗死伴消化道出血患者临床特点的研究

Study on the Clinical Characteristics of Myocardial Infarction Complicated by Gastrointestinal Bleeding in Old Patients

目的总结老年人急性心肌梗死(AMI)伴上消化道出血(UGH)患者的临床特点。方法选择2010年1月至2012年1月湘潭市江麓医院收治的AMI伴UGH的24例患者作为观察组,单纯AMI患者24例作为对照组,分析两组患者的临床表现、疗效,随访1年观察再出血及死亡发生情况。结果观察组有胃肠道病史的比例高于对照组(P<0.05),采用抗凝治疗的比例明显低于对照组(P<0.05);凝血时间长于对照组(P<0.05)。随访1年后,观察组3例死亡,5例再次UGH;对照组2例死亡。结论老年AMI伴UGH患者症状多不明显,易漏诊、误诊,预后差,应及早诊断、治疗。

Objective To summarize the clinical characteristics of myocardial infarction （AMI） complicated by upper gastrointestinal hemorrhage（UGH） in old patients,in order to provide basis for clinical diagnosis and treatment.Methods A total of 24 patients with AMI complicated by UGH admitted in Yiangtan Jianglu hospital from Jan.2010 to Jan.2012 were selected as the observation group,another 24 patients with single AMI were selected as the control group.The clinical manifestations,therapeutic effect of two groups were analyzed.Occurrences of rebleeding and death were observed during the 1-year follow-up.Results Compared with the control group,ratio of patients with history of gastrointestinal disease was significantly higher in the observation group（P 〈0.05）.Ratio of patients received anticoagulation therapy in the observation group was significantly lower than the control group （P 〈 0.05）.The clotting time was longer in the observation group than in the control group （P 〈 0.05）.After one year of follow-up,3 casesof the observation group died,and 5 cases had recurrence of UGH.And 2 cases of the control group died.Conclusion Symptoms of elderly AMI patients complicated by UGH are various and not obvious,which easily results in missed diagnosis,misdiagnosis and poor prognosis.Therefore,it should be early diagnosed and treated.