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目的探讨高龄急性心肌梗死(AMI)患者院内生存情况及其危险因素。方法选取2006年12月至2016年2月收治的AMI患者3 229例,其中,非高龄组患者2 322例,高龄组患者907例。高龄组患者按院内生存情况分为存活组790例(87.1%)与病死组117例(12.9%)。分析高龄组患者的一般情况、既往病史、家族史、临床检查、并发症、治疗方案及院内生存情况。结果高龄患者院内存活率与诊断,治疗方法,入院时红细胞比积,术后血红蛋白水平,使用β受体阻滞剂与他汀类药物比例呈正相关;与Killip 3~4级比例,合并房颤、心源性休克、三度房室传导阻滞比例,病变严重程度,肌钙蛋白峰值,术后肌酐水平呈负相关,差异有统计学意义(P<0.05)。高龄组患者院内病死的危险因素包括STEMI比例,合并心源性休克、室颤比例,入院时血钾水平,肌钙蛋白峰值,治疗方法。结论积极再灌注治疗可改善高龄AMI患者预后,但仍需重视心律失常、心源性休克等危险因素,应加强对高龄患者及其家属的宣教,提高对急性胸痛的认识,做到早发现、早诊治,以期改善高龄AMI患者生存情况。
Objective To investigate the in-hospital survival and its risk factors in elderly patients with acute myocardial infarction (AMI). Methods A total of 3 229 AMI patients were selected from December 2006 to February 2016. Among them, 2 322 were non-elderly patients and 907 were elderly patients. The elderly patients were divided into survivor group (790 cases, 87.1%) and fatal group (117 cases, 12.9%) according to their hospital survival. Analysis of the elderly patients general situation, past medical history, family history, clinical examination, complications, treatment programs and hospital survival. Results There was a positive correlation between in-hospital survival and diagnosis, treatment, admission hematocrit, postoperative hemoglobin level, and the use of β-blockers and statin ratio. Compared with Killip grade 3 to 4, atrial fibrillation, Cardiac shock, the ratio of third degree atrioventricular block, the severity of the disease, the peak value of troponin and postoperative creatinine were negatively correlated (P <0.05). The risk factors for nausea in hospital in elder group were STEMI, cardiogenic shock, ventricular fibrillation, serum potassium level at admission, peak troponin, and treatment. Conclusions Active reperfusion therapy can improve the prognosis of elderly patients with AMI, but still need to pay attention to risk factors such as arrhythmia and cardiogenic shock. The mission of elderly patients and their families should be strengthened and awareness of acute chest pain should be enhanced. Early detection, Early diagnosis and treatment, with a view to improving the survival of elderly patients with AMI.