老年急性心肌梗死的临床特点、影响因素与处理

CLINICAL CHARACTERISTICS OF ACUTE MYOCARDIAL INFARCTION IN ELDERLY PA-TIENTS

目的 探讨老年急性心肌梗死(acute myocardial infarction,AMI)的临床特点。方法 对52例住院的老年AMI患者的临床资料进行回顾性分析。结果 老年AMI患者以胸痛为首发症状的只占40％,以气促为首发症状的占48％,起病到就诊时间1-7d的占63％,只有15％的患者进行溶栓治疗,住院病死率24％。结论 老年AMI患者发病症状不典型,就诊时间延误,并发多种疾病,误诊、漏诊率高,溶栓率低,心衰、休克、心律失常等并发症较为常见,病死率高。老年患者尤其有呼吸困难、上腹痛等症状者应做心电图及心肌酶检查,如无禁忌证,早期溶栓可改善预后,已确诊的老年AMI患者综合治疗要慎重全面。

Objective To explore the clinical characteristics of acute myocardial infarction in elderly patients. Methods The elderly patients with acute myocardial infarction diagnosed from January 2000 to January 2002 in our hospital were retrospectively analyzed. Results The number of patients with chest pain as the first symptom were 21(40%) and with breathe hard as the first symptom were 25 (48% ). The time from the first symptom of AMI occurred to go to hospital was 24h to a week. About 15% cases were given thrombolytic therapy, the fatality rate was 24 %. Conclusion The study shows that many factors affect the prognosis of AMI in elderly patients and result in higher fatality rate, such as not typical symptoms, go to hospital delayed, companied with many other diseases, higher misdiag-nosis and missed diagnosis rate, lower thrombolytic rate, more common complications as cardiogenic shock, heart failure and arrhythmia. The application of ECG and measurement of creatine kinase isoen-zyme could help diagnosis of AMI in elderly patients and the thrombolytic therapy should be considered for elderly patients( >70 - year - old) .