老年急性心肌梗死并发心源性休克的临床特征及介入治疗的预后研究

Clinical features of elderly patients with cardiogenic shock induced by acute myocardial infarction and the prognosis after invasive treatment

目的回顾性分析高龄(年龄>75岁)急性心肌梗死患者合并心源性休克的临床特征及介入治疗对其预后的影响。方法入选2007年6月~2012年12月解放军火箭军总医院老年急性ST段抬高型心肌梗死(STEMI)患者142例(年龄>75岁),分为心源性休克组(CS组)(63例)及非心源性休克组(非CS组)(79例),比较两组患者年龄、性别、既往病史、心肌梗死部位、左心室射血分数及血肌酐清除率等临床资料;并进一步将CS组的患者分为介入组(27例)及非介入组(36例),分析两个亚组患者的临床资料(年龄、性别、既往病史、心肌梗死部位、左心室射血分数及血肌酐清除率等)及预后(心律失常、院内死亡率、住院时间等)。结果 CS组年龄大于非CS组,而左室射血分数显著低于非CS组(P<0.05)。CS介入组患者的心律失常发生率、院内死亡率均明显低于非介入组(P<0.05),平均住院时间、主动脉内球囊反搏治疗(IABP)及呼吸机撤机时间也同样明显缩短(P<0.05),同时,介入组患者的左室射血分数有所改善(P<0.05)。结论介入再灌注治疗可以减少高龄患者心肌梗死后心律失常等相关并发症的发生率,同时改善心脏功能,最终减少院内死亡率,缩短住院时间。

Objective To analyze the clinical features of elderly patients with cardiogenic shock （CS） induced by ST- segment elevation myocardial infarction （STEMI） retrospectively and the influnce of invasive treatment on prognosis. Methods A total of 142 elderly patients （aged 〉75years） with STEMI in General Hospital of PLA Rocket Force from Junary 2007 to December 2012 were divided into CS group （n=63） and nor-CS group （n=79）. The clinical data of age, sex, medical history, myocardial infarction area, left ventricular ejection fraction （LVEF） and creatinine clearance rate were compared between the two groups. Meanwhile, STEMI patients complicated by CS were divided into invasive group （n=27） and non-invasive group （n=36）. The baseline information （age, sex, medical history, myocardial infarction area, LVEF, creatinine clearance rate） and clinical prognosis （morbidity of arrhythmia, the duration of IABP and respi- rator, mortality in hospital, length of stay） were compared. Results The patients in CS group were older than non-CS group, however, the LVEFs were significantly decreased in CS group, compared with non-CS group （P 〈 0.05）. Com- pared with non-invasive group, in invasive group the incidence of arrhythmia, mortality in hospital, and the duration of IABP and respirator, average hospital stay were significantly deceased （P 〈 0.05）; however, the LVEFs were increased （P 〈 0.05）. Conclusion Invasive treatment can reduce the incidence of arrhythmia, improve cardiac function of elderly patiens with CS induced by STEMI, in order to reduce hospital mortality, shorten hospitalization time.