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|本期目录/Table of Contents|

老年急性心肌梗死146例临床特点与近期预后分析

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2013年第2期
页码:
220-223
栏目:
临床研究
出版日期:
2013-04-25

文章信息/Info

Title:
Clinical characteristics and prognosis of 146 elderly patients with acute myocardial infarction
作者:
赵喜萍1; 杨 军2
(1.大连市沙河口区医院急诊科，辽宁 大连 116021；2.大连医科大学附属第二医院，辽宁 大连 116023)
Author(s):
ZHAO Xi-ping1;  YANG Jun2
(1.Department of Emergency, Shahekou Hospital, Dalian 116021, Liaoning, China; 2.Second Hospital, Dalian Medical University, Dalian 116023, Liaoning, China)
关键词:
心肌梗死; 老年人; 预后; 死亡率
Keywords:
myocardial infarction;  elderly;  prognosis;  mortality
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
目的:分析老年急性心肌梗死（AMI）患者临床特点与近期预后。方法： 对2005年1月~2010年5月在我院住院治疗老年（年龄≥65岁）AMI患者电子病例数据146例进行回顾性分析。包括年龄、性别、梗死部位、发病时间、发病月份、就诊时间、临床症状和30 d心血管事件等进行分析。结果： 共计146例患者入选。其中男性57例（39.0%）、年龄（72±6）岁；女性89例（61.0%）、年龄（77±9）岁（均P<0.05）。男性以前壁心肌梗死较多（40例，27.4%）（P<0.05）。女性以下壁、右室壁、侧壁较多（65例，44.5%）（P<0.01）。老年AMI患者在早上05:00～08:59时段发病人数最多53例（36.3%）、17:00～20:59时段最少为9例（6.2%）（P<0.01）。发病月份以10月（23例，15.8%）、1月（21例，14.4%）及3月（23例，15.8%）较多，5月份最低（3例，2.0%）（P<0.01）。发病12 h内就诊人数为44例（30.1%）、12～48 h时段最多为88例（60.3%）（P<0.01）。就诊时间延迟。 首发胸痛、胸闷典型症状29例（19.9%）、其他不典型症状117例（80.1%）（P<0.01）。30 d心血管终点事件：老年AMI患者严重缓慢心律失常和联合终点事件病死率、心力衰竭、Ⅲ度AVB和心室停搏致死性心律失常发生率，女性组高于男性组（均P<0.05）。心室颤动病死率、心室颤动和持续性室速致死性心律失常发生率，男性组高于女性组（均P<0.05）。结论： 老年AMI患者在构成比、年龄、梗死部位、心力衰竭、致死性心律失常和病死率类型存在性别差异。在早上05:00～08:59时段发病人数最多。发病月份以10月、1月、3月较多。发病在12～48 h时段就诊人数最多。发病后不典型临床症状人数较多。
Abstract:
AIM:To identify high-risk patients in a timely manner, reduce the incidence of complications and apply effective treatment by analyzing the clinical features and prognosis in elderly patients with acute myocardial infarction (AMI). METHODS: Data of 146 elderly AMI patients (age ≥65 years) treated from January 2005 to May 2010 in our hospital were retrospectively analyzed, including age, gender, infarct location, onset time, onset month, time of hospital arrival, clinical symptoms, and cardiovascular events during the prior 30 days. RESULTS: Of the 146 patients, 57 were male (39.0%), ages (72±6) years and 89 were female (61.0%), ages (77±9) years (P<0.05). The incidence of anterior myocardial infarction was higher in male patients (40 cases, 27.4%) (P<0.05) and the incidence of inferior, right ventricular, and lateral myocardial infarctions were higher in female patients (65 cases, 44.5%) (P<0.01). The most frequent time of was from 05:00-08:59 am (53 cases, 36.3%), whereas the least frequent time was from 17:00-20:59 (nine cases, 6.2%) (P<0.01). The most frequent months of onset were October (23 cases, 15.8%), January (21 cases, 14.4%) and March (23 cases, 15.8%). Forty-four patients (30.1%) arrived at the hospital within 12 h and 88 cases (60.3%) arrived at the hospital from 12 h to 48 h (P<0.01). Twenty-nine cases (19.9%) had typical symptoms of chest pain and chest tightness, and 117 cases (80.1%) had other atypical symptoms (P<0.01). From the 30-day cardiovascular events it was reported that for elderly AMI patients with bradyarrhythmia and combined end point mortality, heart failure, III° AVB, incidence of sinus arrest and fatal arrhythmia of females is higher than the male group (all P<0.05), whereas ventricular fibrillation mortality, ventricular fibrillation, sustained ventricular tachycardia and incidence of lethal arrhythmia in males is higher than in females (all P<0.05). CONCLUSIONS: Elderly AMI patients show a gender difference in constituent ratio, age, infarct location, heart failure, type of fatal arrhythmias and mortality. Incidence of the maximum period is from 05:00 am to 08:59 am, and peak incidence months are October, January, and March. The number of hospital arrivals is highest at 12-48 h after onset. Most subjects have atypical clinical symptoms.

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备注/Memo

备注/Memo:
收稿日期：2012-10-12.作者简介：赵喜萍，副主任医师Email:yj1813027@163.com
更新日期/Last Update: 2013-04-28