高龄急性心肌梗死患者院内生存情况回顾性分析

In-hospital mortality and risk factors for very elderly patients with acute myocardial infarction:a retrospective analysis

目的探讨高龄急性心肌梗死(AMI)患者院内生存情况及其危险因素。方法选取2006年12月至2016年2月收治的AMI患者3 229例,其中,非高龄组患者2 322例,高龄组患者907例。高龄组患者按院内生存情况分为存活组790例(87.1%)与病死组117例(12.9%)。分析高龄组患者的一般情况、既往病史、家族史、临床检查、并发症、治疗方案及院内生存情况。结果高龄患者院内存活率与诊断,治疗方法,入院时红细胞比积,术后血红蛋白水平,使用β受体阻滞剂与他汀类药物比例呈正相关;与Killip 3~4级比例,合并房颤、心源性休克、三度房室传导阻滞比例,病变严重程度,肌钙蛋白峰值,术后肌酐水平呈负相关,差异有统计学意义(P<0.05)。高龄组患者院内病死的危险因素包括STEMI比例,合并心源性休克、室颤比例,入院时血钾水平,肌钙蛋白峰值,治疗方法。结论积极再灌注治疗可改善高龄AMI患者预后,但仍需重视心律失常、心源性休克等危险因素,应加强对高龄患者及其家属的宣教,提高对急性胸痛的认识,做到早发现、早诊治,以期改善高龄AMI患者生存情况。

Objective To investigate the in-hospital mortality and risk factors among the very elderly acute myocardial infarction（AMI） pa- tients. Methods A retrospective study was performed on 3 229 very elderly AMI patients who were admitted from December 2006 to February 2015. All the patients were divided into the non-elderly group（ n = 2 322 ） and the elderly group（ n = 907 ）. According to their in-hospital survival condition, the patients in elderly group were assigned into the survival group（ accounted for 87. 1% ,n = 790 ） and death group （ ~ceounted for t2.9% , rr = t 17 ）. The genera[ condition, mediea[ history, family history, admission examination, complica- tions,clinical diagnosis,treatment and in-hospital survival condition were compared and analyzed. Resdts In-hospital survival rate was positively correlated with diagnosis, treatment, red blood cell volume, postoperative hemoglobin levels, use of beta blockers and st- atins ratio;while it was negatively correlated with Killip 3-4 grade proportion, atrial fibrillation, cardiac shock, three degree atrioventric- ular block ratio, disease severity and troponin peak, all the differenceshad statistical significance （ P 〈 0. 05 ）. The in-hospital mortality risk factors for elderly patients were the ratio of STEMI, combined with cardiac shock, ventricular fibrillation, potassium levels on ad- mission, the peak troponin and the treatment. Conclusion Active reperfusion therapy can improve the prognosis of elderly patients with AMI,while still needs to be payed attention to heart failure, cardiogenic shock and other risk factors for elderly patients and their families should strengthen education, improve the understanding of coronary heart disease and acute chest pain, early detection and ear- ly treatment, in order to improve the prognosis of elderly patients with AMI.