在院发生与新入院急性心肌梗死的对比分析

目的 对比在院发生急性心肌梗死（AMI）与新入院AMI患者的发病、治疗及预后特点.方法 记录2013年1月至2014年1月中国人民解放军第422医院AMI患者的发病、治疗及预后信息,根据是否为住院期间发生的AMI,分为在院组和新入院组,对比两组基线资料、治疗和预后指标,分析其相关因素.结果 共纳入105例患者,新入院组90例,在院组15例,在院与新入院发生AMI患者的年龄、性别、高血压、糖尿病、高脂血症等比较,差异均无统计学意义（P＞0.05）.在院组患者重要脏器受累较新入院组多（P＜0.001）,其中基础呼吸系统疾病、脑疾病和运动功能不全比较,差异均有统计学意义（P＜0.05）.在院组患者严重电解质紊乱7例（46.7％）,新入院组21例（23.3％）,差异无统计学意义（P=0.058）.在院组患者死亡7例（46.7％）,新入院组死亡6例（6.7％）,差异有统计学意义（P＜0.001）.在院组行经皮冠状动脉介入治疗（PCI）的患者2例（13.3％）,新入院组42例（46.7％）,差异有统计学意义（P=0.027）,症状发作时间过长和家属拒绝为主要原因.结论 与新入院AMI比较,在院患者发生AMI预后差,死亡率高,可能与衰竭器官多、对介入治疗态度消极相关.

Clinical comparison between in-hospital acute myocardial infarction and patients admitted for new acute myocardial infarction

Objective To compare the onset,treatment and prognosis characteristics of acute myocardial infarction occurred during hospitalization and patients newly acquired AMI out of hospital,prospectively.Methods From January 2013 to January 2014,the information of disease onset,treatment and prognosis of the patients with acute myocardial infarction were recorded.Those patients were divided into two groups,the hospitalization group and the new admissions group,according to whether the acute myocardial infarction occurred during hospitalization.The patients＇ baseline information,disease situation,treatment method and prognosis were compared between the two groups.Results A total of 105 patients were included,of which 90 cases in new admissions group,and 15 cases in the hospitalization group.There is no significant difference on age,gender,and hypertension,diabetes and high cholesterol history （P ＞ 0.05）.The organ and system involvement were more seriousin the hospitalization group patients （P ＜ 0.001）,and lung disease,cerebrovascular disease and motor dysfunction were higher in the hospitalization group （P ＜ 0.05）.The incidence of severe electrolyte imbalance was higher in the hospitalization group （46.7％）,but without statistical differenceas compared with the new admissions group （P =0.058）.The proportion accepted intervention treatment was low in both group,and lower in the hospitalization group （46.7％ vs.6.7％,P=0.027）,and the before-hospital-delay and family refusal were the main reasons.The mortality rate was significantly higher in the hospitalization group （13.3％ vs.46.7％,P ＜ 0.001）.Conclusions Compared with the newly admitted patients,the hospitalization patients complicated with acute myocardial infarction showed poorer prognosis and higher mortality,and that might be related to multiple organ dysfunction and passive acceptance of interventional treatment.