不同性别急性心肌梗死患者临床症状及PCI术后效果的差异性研究

Difference study of clinical symptoms and postoperative effects of PCI in patients with acute myocardial infarction of different genders

目的 探讨不同性别急性心肌梗死患者临床症状及PCI术后效果的差异.方法 选择河南大学第一附属医院2013年1月至2015年10月收治的182例急性心肌梗死患者作为研究对象,根据性别不同予以分组,男性102例,女性80例.所有患者均于就诊1周内予以选择性冠状动脉造影及PCI手术,比较男性与女性基线资料、临床症状及PCI术后效果的差异.结果 男性患者平均年龄为（61.6±6.9）岁,低于女性（68.7±9.4）岁;LVEF为（65.3±4.8）％,高于女性（49.7±5.4）％;男性患者中30例（29.4％）合并高血压,少于女性的38例（47.5％）,19例（18.6％）合并糖尿病,少于女性的33例（41.3％）,70例（68.6％）有吸烟史,明显多于女性的7例（8.8％）,差异均有统计学意义（P均＜0.05）.男性患者中持续性剧烈胸痛、大汗、胸闷、放射痛等临床症状发生率均高于女性患者,女性患者恶心呕吐及无症状发生率则明显高于男性患者,差异均有统计学意义（P均＜0.05）.男性患者非靶血管狭窄、术后TIMI血流＜3级、并发心力衰竭、并发肺炎、住院期间死亡等的发生率分别为56.9％、2.0％、3.9％、2.9％、3.9％,低于女性患者72.5％、11.3％、12.5％、11.3％、12.5％,差异有统计学意义（P＜0.05）.结论 男性心肌梗死发病率高于女性,且发病年龄更小,合并高血压、糖尿病及吸烟史等危险因素概率更大,但病情较女性患者轻;女性患者临床症状以恶心呕吐为主或无症状,缺乏典型性,因而治疗易被延误而导致PCI术的预后差于男性,提示女性患者更易注重定期身体检查.

Objective To investigate the differences in clinical symptoms and postoperative effects of PCI in patients with acute myocardial infarction of different genders. Methods 182 cases of patients with acute my- ocardial infarction who were treated in our hospital between January 2013 and October 2015 were included in the study. The patients were grouped according to different genders. 102 cases were male and 80 cases were female. All patients were treated with elective coronary angiography and PCI within 1 week. The baseline data, clinical symptoms and postoperative effects of PCI were compared between male and female patients. Results The average age of male patients was lower than that of female patients [（61.6±6.9）years old vs （68.7±9.4）years old]. LVEF was higher than that in female patients [ （65.3±4.8）% vs （49.7±5.4）% ]. Among the male patients, there were 30 cases（29.4%） with hypertension, fewer than 38 cases（47.5%） in female patients. 19 cases（18.6%） were with di- abetes mellitus, fewer than 33 cases（41.3%） in female patients and 70 cases（68.6%） had smoking history, sig- nificantly more than 7 cases（8.8%） in female patients（P〈0.05）. The incidence rates of clinical symptoms such as persistent severe chest pain, profuse sweating, chest distress and radiation pain in male patients were higher than those in female patients. The incidence rates of nausea and vomiting and asymptom in female patients were signifi- cantly higher than those in male patients （P〈0.05）. The incidence rates of non-target angiostenosis, postoperative TIMI blood flow〈grade 3, with heart failure, with pneumonia and death during hospitalization in male patients（56.9%, 2.0%, 3.9%, 2.9%, 3.9%） were lower than those in female patients （72.5%, 11.3%, 12.5%, 11.3%, 12.5%）（P〈0.05）. Conclusion The incidence of myocardial infarction in male patients is higher than that in the female, and the age of onset is smaller. The probabilities of being complicated with hypertension, diabetes, smok- ing history and other risk factors are higher but the condition is better than that of the female. However, the main clinical symptoms of female patients are nausea and vomiting or asymptom, lack of typicalness. Therapy, it is easy to appear that delay caused PCI prognosis is poorer than that of the male, which indicates that female patients should pay more attention to regular physical examination.