老年人急性心肌梗死临床特点分析

目的分析老年人急性心肌梗死（AMI）的临床特点。方法收集急性心肌梗死患者186例,按年龄分成老年组与中青年组进行分析。分别比较两组临床症状、并发症、心血管危险因素等,从而总结出老年急性心肌梗死患者的临床特征。结果与中青年组比较,老年组中女性患者明显增多,有吸烟史、早发冠心病家族史、超重或肥胖患者比例低（P〈0.01）,而患糖尿病、高血压和高脂血症的机率差异无统计学意义（P〉0.05）;老年组首发症状不典型,心肌梗死典型心绞痛症状的发生率低,以心外症状为主（P〈0.001）;心律失常、心源性休克、肺部感染等并发症多于中青年组（P〈0.05）;梗死部位两组比较差异无统计学意义（P〉0.05）;心功能Ⅲ级以上者明显多于青年组（P〈0.001）;多支病变发生率高于中青年组（P〈0.001）;确诊时间以大于12h以上的为主（P〈0.001）;积极治疗率（介入治疗、溶栓治疗）明显低于中青年组（P〈0.01）,误诊率、死亡率明显高于中青年组（P〈0.05）。结论老年急性心肌梗死以女性患者比例为多;以无胸痛症状者为多,心外症状为主;心功能较差;常伴有心律失常、心源性休克、肺部感染等并发症;多支病变发生率高,误漏诊率高,及时诊断、治疗率低,病死率高。

Clinical feature of acate myocardial infarction in old people

Objective To further explore the clinical characteristics of acute myocardial infarction(AMI) in old patients.Methods 186 consecutive patients with AMI were divided into youth group and elderly group.The risk factors,clinical course,complications and prognosis of AMI were compared among 2 groups.Results Compared with the young,the elderly female patients had a smoking history,family history of premature coronary heart disease and overweight or obese patients(P<0.01),but there was no differences of suffering from diabetes,hypertension and hyperlipidemia;in old group,symptoms of myocardial infarction was in a low incidence of typical angina,and heart outside symptoms was main(P<0.001);patients with arrhythmia,cardiogenic shock,pulmonary infection and other complications was more than younger patients(P<0.05).There was not significant difference in infarction site between 2 groups.The number of patients with cardiac function Ⅲ,vessel disease in old group was larger than that in the young group(P<0.001).Patients with initial consulting time >24 h were more in elderly female group(P<0.001).The misdiagnosis rate,mortality rate in old group was significantly higher than those in the young group(P<0.05).Conclusion The elderly female patients with acute myocardial infarction was much more than other group,and they were often accompanied by arrhythmia,cardiogenic shock,pulmonary infection and other complications,with high incidence rate of missed diagnosis,timely diagnosis,high mortality.