急性ST段抬高心肌梗死患者住院死亡原因分析

目的探讨影响急性ST段抬高心肌梗死(STEMI)患者住院死亡的相关因素,为临床急性心肌梗死(AMI)预防和治疗提供理论依据。方法对134例急性ST段抬高心肌梗死患者进行回顾性分析。根据住院期间死亡与否分成两组:死亡组和存活组。分别记录其一般情况、病史特征、心电图特征及诊断、化验结果、治疗及预后等方面,比较两组间差异及其原因。结果单因素分析结果显示:随着年龄增加、入院心率加快、收缩压和舒张压较低、合并房颤、感染及心源性休克患者住院病死率明显增加;急诊PCI术患者病死率明显降低。应用阿司匹林、替罗非班和ACEI药物治疗患者病死率明显降低(P0.05)。多因素Logistic回归分析结果显示:急性ST段抬高心肌梗死入院CKMB明显升高患者住院病死率明显升高,合并心源性休克患者住院病死率明显升高(P0.05)。结论急性ST段抬高心肌梗死患者入院时CKMB升高程度越高及是否合并心源性休克,对预测的近期预后具有十分重要临床价值。

Clinical analysis of acute ST-elevation myocardial infarction patients died in hospital

Objective To explore the related factors of the recent prognosis and provide the theoretical basis for prevention and treatment for ST-elevation myocardial infarction(STEMI) patients.Methods A retrospective study of 134 ST-segment elevation acute myocardial infarction was conducted and the database from 2006 to 2010 was analysed and compared.According to different results during hospitalization,patients were divided into two groups: death group and survival group.The history characteristics and ECG features were recorded;diagnosis,treatment and prognosis were compared.Results In this study,univariate analysis showed that the patients in death group were more than the patients in survival group with increasing age,decreased systolic and diastolic blood pressure,having higher CKMB and with cardiogenic shock on admission(P<0.05).Application of emergency PCI intervention,aspirin and ACEI drug therapy significantly reduced mortality(P<0.05).Binary logistic regression analysis identified only two predictor variables for the prognosis of STEMI inpatients.Patients reporting early to the hospital,having higher CKMB and with cardiogenic shock on admission,were likely to have worse prognosis during their hospital stay(P<0.05).Conclusion Higher CKMB and cardiogenic shock on admission are the most powerful predictors for cardiac events in patients with premature STEMI.