女性急性心肌梗死患者院内生存情况及危险因素分析

In-hospital survival rate and risk factors of female acute myocardial infarction patients

目的探讨女性急性心肌梗死(AMI)患者院内生存情况及危险因素。方法选择AMI患者2667例,其中男性2042例(男性组),女性625例(女性组)。女性组按院内生存情况又分为生存组565例,死亡组60例。分析女性组与男性组一般情况、既往病史、家族史、临床检查、并发症、治疗及生存情况。结果女性组院内病死率明显高于男性组(9.6%vs 5.3%,P<0.01),其中接受PCI患者病死率明显低于未行PCI患者(5.1%vs 25.7%,P<0.01),急诊PCI患者病死率明显高于择期PCI患者(10.1%vs 2.5%,P<0.01)。女性AMI患者院内预后与ST段抬高型心肌梗死、红细胞比容、治疗方法、β受体阻滞剂、他汀类药物呈正相关,与年龄、重度心力衰竭、心源性休克、三度房室传导阻滞、心房颤动、肌钙蛋白T峰值、术后肌酐呈负相关(P<0.05,P<0.01)。女性AMI患者院内死亡的独立危险因素包括年龄、尿素、肌钙蛋白T峰值、主动脉内球囊反搏及他汀类药物(P<0.05,P<0.01)。结论临床需更加关注女性发病情况,重视尿素、肌钙蛋白水平及使用主动脉内球囊反搏、最优化药物治疗等。

Objective To study the in-hospital survival rate and risk factors of female acute myo eardial infarction （AMI） patients. Methods A total of 2667 AMI patients were divided into male group （n=2042） and female group （n=625）. The patients in female group were further divided into survival group （n=565） and death group （n= 60）,and their general condition,past medical history, family history, clinical examination findings, complications, therapies and in-hospital survival rate were compared and analyzed. Results The in-hospital mortality was significantly higher in female group than in male group,in patients who received PCI than in those who did not receive PCI,and in patients who received emergency PCI than in those who received elective PCI （9.6% vs 5.3%,P〈0.01;5.1% vs 25.7% ,P〈0.01;10.1% vs 2.5%,P〈0. 01）. The in-hospital outcome of female AMI patients was positively related with STEMI, erythrocyte specific volume, thera- pies,β-receptor blockers, use of statins and negatively related with age, severe heart failure, car diogenic shock, atrioventricular block, AF, troponin T peak value, and postoperative creatinine level （P〈0.05,P〈0.01）. Age, urea, troponin T peak value, intraartery saccular counterpulsation, use of statins were the independent risk factors for in-hospital mortality in female AMI patients （P〈0.05,P〈0.01）. Conclusion More attention should be paid to the onset of disease, urea and troponin level,intraartery saccular counterpulsation and optimized drug therapies in female AMI patients.