| 摘要: |
| 目的 探讨导致急性心肌梗死(AMI)患者院内死亡的原因并分析可预测院内死亡的因素。方法 回顾性分析2006年12月至2012年1月入院的1 319例AMI患者的一般情况、既往病史及家族史、入院时检查、临床诊断、并发症、治疗情况及院内死亡、死亡原因。结果 (1)近5年AMI院内死亡率为7.4%,其中女性死亡率高于男性(13.2% vs 5.9%,P=0.000),未手术者死亡率高于手术者(31.4% vs 3.4%,P=0.000),急诊手术的患者死亡率高于择期手术的患者(5.0% vs 2.2%,P=0.008)。心源性休克的发生率为10.6%;并发心源性休克患者的死亡率达47.1%,其中未手术的患者死亡率明显高于急诊手术的患者和择期手术的患者(80.4% vs 34.5%、17.6%,P=0.000)。(2)AMI患者院内死亡(控制性别)与年龄、尿酸、尿素、肌酐、胱抑素C、血糖、白细胞、肌钙蛋白峰值、B型钠尿肽(BNP)、并发心律失常、并发心源性休克、并发Killip 3～4级、使用主动脉内球囊反搏(IABP)、未手术治疗呈正相关;与红细胞、血红蛋白、红细胞压积、药物使用率呈负相关。(3)女性、年龄大、高尿素、高血糖、高肌钙蛋白峰值、高BNP、并发心律失常、并发心源性休克、并发Killip 3～4级、未手术治疗、使用IABP、未使用药物是院内死亡的独立危险因素。结论 积极再灌注治疗是改善AMI患者尤其是并发心源性休克者早期预后的最佳治疗措施。应重视年龄、尿素、血糖、肌钙蛋白峰值、BNP对判断预后的价值并提高胱抑素C的检测率。 |
| 关键词: 心肌梗死 医院死亡率 预测因素 经皮冠状动脉介入术 |
| DOI： |
| 投稿时间：2013-04-09修订日期：2013-05-16 |
| 基金项目: |
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| In-hospital death of acute myocardial infarction patients and the influencing factors: a retrospective analysis |
| LI Wen wen△,MA Li ping△,QIN Yong wen,ZHENG Xing,ZHAO Xian xian* |
(Department of Cardiovasology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
△Co-first authors.
*Corresponding author.) |
| Abstract: |
| Objective To investigate the causes of in-hospital death of acute myocardial infarction(AMI) patients and to analyze the independent predictors of the death. Methods We retrospectively analyzed the clinical data of 1 319 AMI patients who were treated from December 2006 to January 2012 in our hospital, and the data included the general condition, medical history and family history, admission examination, clinical diagnosis, complication, treatment and in-hospital death and the reasons. Results (1)The in-hospital mortality rate of AMI patients was 7.4% in the past five years in our hospital, with the rate of female being significantly higher than that of males (13.2% vs 5.9%,P=0.000), with those who received no operation being significant higher than those received (31.4% vs 3.4%,P=0.000), and with those received emergent operation being significantly higher than those received selective operation (5.0% vs 2.2%,P=0.008).The incidence rate of cardiogenic shock was 10.6% in patients with AMI, and they had an in-hospital death rate of 47.1%, with those received no operation being significantly higher than those received emergent and selective operation (80.4% vs 34.5%, 17.6%, P=0.000).(2)The in-hospital death (controlling gender) was positively associated with age, urea acid, blood urea nitrogen, creatinine, cystatin C, glucose, white blood cell, peak concentration of troponin, B-type natriuretic peptide (BNP), presence of arrhythmia, cardiogenic shock, Killip 3-4 group, placement of intraaortic balloon pump (IABP), and receiving no operation, and was negatively associated with red blood cell, hemoglobin, hematocrit, and use of drugs.(3)Independent risk factors of in-hospital death of AMI patients included: female sex, older age, high level of blood urea nitrogen, glucose, peak concentration of troponin and BNP, presence of arrhythmia, cardiogenic shock, Killip 3-4 group, receiving no operation, placement of IABP, and receiving no drugs. Conclusion Prompt reperfusion is the best treatment choice for AMI patients, especially for those presenting with cardiogenic shock. More emphasis should be given to predictors of in-hospital mortality, such as age, blood urea nitrogen, glucose, peak concentration of troponin and BNP; also cystatin C should be examined for more patients with AMI in clinic. |
| Key words: myocardial infarction hospital mortality predictors percutaneous coronary intervention |
