合并缺血性脑卒中老年急性心肌梗死患者院内不良事件分析

Adverse events in hospitalized elderly acute myocardial infarction patients with ischemic stroke

目的探讨合并缺血性脑卒中老年急性心肌梗死患者临床特点及导致院内不良事件的独立危险因素。方法选择2010年1月~2017年12月在首都医科大学附属北京安贞医院心内科监护室收治的急性ST段抬高型心肌梗死患者519例,根据既往是否合并缺血性脑卒中史分为脑卒中组105例,对照组414例,分析临床特点和院内不良事件,采用多元logistic回归分析2组发生院内不良事件的主要独立危险因素。结果与对照组比较,脑卒中组年龄、高血压和糖尿病比例明显升高,收缩压、LVEF水平明显降低,差异有统计学意义(P<0.05,P<0.01)。脑卒中组院内死亡、心源性休克、恶性心律失常、多器官功能衰竭比例明显高于对照组(8.6%vs 2.4%,15.2%vs 7.7%,8.6%vs 3.1%,18.1%vs 5.6%,P<0.05,P<0.01)。脑卒中组接受主动脉内球囊反搏、机械通气、持续性肾脏替代治疗比例明显高于对照组(P<0.01)。logistic回归分析发现,缺血性脑卒中、高血压、糖尿病、心功能Killip分级Ⅲ~Ⅳ级、年龄≥65岁、LVEF≤50%、收缩压≤90mm Hg(1mm Hg=0.133kPa)是合并缺血性脑卒中急性ST段抬高型心肌梗死患者发生院内不良事件的独立危险因素(P<0.05,P<0.01)。结论合并有缺血性脑卒中老年急性心肌梗死患者院内不良事件发生率高。

Objective To study the clinical characteristics and risk factors of elderly acute myocardial infarction（AMI）patients with ischemic stroke（IS）.Methods Five hundred and nineteen AMI patients with ST segment elevation were divided into IS group（n=105）and IS-free group（n=414）.Their clinical data and major risk factors for adverse events were analyzed by multivariate logistic regression analysis.Results The age was significantly older,the incidence of hypertension and diabetes mellitus（DM）was significantly higher while the SBP and LVEF were significantly lower in IS group than in IS-free group（P〈0.05,P〈0.01）.The rate of death and incidence of cardiogenic shock,malignant arrhythmia and multiple organ failure were significantly higher in IS group than in IS-free group（8.6%vs 2.4%,15.2%vs 7.7%,8.6%vs 3.1%,18.1%vs5.6%,P〈0.05,P〈0.01）.The ratio of patients who underwent IABP,mechanical ventilation,continuous renal replacement therapy was significantly higher in IS group than in IS-free group（P〈0.01）.Multivariate logistic regression analysis showed that IS,hypertension,DM,Killip Ⅲ-Ⅳ,age≥65 years,LVEF≤50%,SBP≤90 mm Hg were the independent risk factors for adverse events in hospitalized AMI patients with IS and ST segment elevation（P〈0.05,P〈0.01）.Conclusion The incidence of adverse events is high in hospitalized AMI patients with IS.