老年人急性非Q波心肌梗死伴腹痛10例

本文报道在我所院前抢救中，表现为胃肠道症状明显，尤其以腹痛为主的10例无Q波老年人急性心肌梗死。     

非心肌梗死性Q波临床意义探讨

目的对无心肌梗死(NMI)者心电图出现的异常Q波进行分析,探讨其临床意义。方法对26列NMIQ波心电图,根据Q波振幅(Q>1/4R)、Q波时间(Q≥0.04s)分为非梗死Q波A组(Q>1/4R)、B组(Q≤1/4R),对比两组Q波时限。并与梗死性Q波(C组)Q波时限进行比较,同时观察非梗死性Q波的心电图特点。结果B组Q波时限(0.055±0.02),C组Q波时限(0.121±0.028),P<0.05,A组Q波时限(0.113±0.016),与C组Q波比较,P>0.05。26例中有92.3%病人伴有器质性疾病。结论A组、B组与C组Q波时限有差异,A组、B组Q波发生呈一过性、可逆性改变,与器质性疾病密切相关。     

肥厚型心肌瘸的病理性Q波

当QRS波群的初始向量背离某个心电图导联的探查电极时，可记录到Q波。根据Q波振幅的大小分别用大写的“Q”和小写的“q”来表示。正常Q波的标准是：振幅低于同导联R波的1／4。时限〈30ms。病理性Q波或异常Q波是指：心电图某些导联上QRS波群起始的负向波。时限≥30ms．振幅〉同导联R波的1／4。病理性Q波可由各种不同类型的心脏解剖异常引起．也可由一些异常的心电生理变化引起。病理性Q波主要见于心肌梗死。但许多研究表明。病理性Q波也是心电图诊断肥厚型心肌病（HCM）的重要依据之一。     

非Q波与Q波心肌梗死的临床分析

本组急性心肌梗死１１２１例中，非Ｑ波心肌梗死３９２例（３５％），Ｑ波心肌梗死７２９例（６５％）。既往有心绞痛及心肌梗死者，在非Ｑ波心肌梗死组分别有７６．８％及３８．８％，显著地多于Ｑ波心肌梗死组的６１．２％及３０．６％。有高血压、糖尿病史及吸烟者，两组间比较无差别。并发泵衰竭、室性心动过速和（或）心室颤动及Ⅱ～Ⅲ度房室传导阻滞者，在非Ｑ波心肌梗死组分别有１０．２％、１０％及１．５％，显著地少于Ｑ波心肌梗死组的１９．３％、２０．６％及１３．６％。梗死后心绞痛者，在非Ｑ波心肌梗死组有４５．２％，显著地多于Ｑ波心肌梗死组的２８．９％。４周病死率，在非Ｑ波心肌梗死组为２．８％，显著地低于Ｑ波心肌梗死组的８．２％。非Ｑ波与Ｑ波心肌梗死比较，患者在急性期并发症较少，病死率较低；而梗死后早期心绞痛较多。     

17例老年人无痛性Q波心肌梗死心电图临床诊断探讨

目的 探讨老年人无痛性Q波心肌梗死（ONPQMI）心电图（ECG）改变与临床诊断特点。方法 回顾性分析17例的ECG改变与临床症状的关系。结果 17例中STT抬高符合Q波急性心肌梗死（AMI）13例,抢救治疗无效死亡6例;符合陈旧性及恢复期心梗（MI）。1例。结论 异常Q波,ST-T动态改变或T波倒置,结合临床病史和相关检查全面分析,除外非梗死性Q波．ECG对ONPQMI有重要诊断意义。     

老年人无Q波与Q波型心肌梗死临床病理对照

老年人无Ｑ波与Ｑ波型心肌梗死临床病理对照毛利民王家惠钱贻简曹素艳马正中陈曼丽林凤茹一、临床及病理资料１．我院老年病房自１９６４年２月至１９９４年７月共收治老年急性心肌梗死（ＡＭＩ）患者２０２例，其中首次为无Ｑ波心肌梗死（ＭＩ）者５６例（占２７．７％）...     

Q波进展型急性心肌梗死2例

例１患者男性 ,４３岁。吸烟后喉部灼痛伴胸闷、乏力、出汗２０ｍｉｎ就诊。体检 :ＢＰ１４／１０ｋＰａ(１０５／７５ｍｍＨｇ) ,两肺无殊 ,心率８２次／ｍｉｎ ,心律齐 ,各瓣膜无杂音。心电图 (图１Ａ)示窦性心律 ,心率７１次／ｍｉｎ ,ＴⅡ、Ⅲ、ａＶＦ 及ＴＶ２～Ｖ６ 增高或高耸 ;对应导联Ⅰ、ａＶＬ倒置 ,ＱＲＳ波群Ｖ１、Ｖ２ 呈Ｒｓ型,有巨大Ｊ波,Ｖ７～Ｖ９ 呈Ｑｒ型 ,疑为下后侧壁极早期心肌梗死 ,留院观察。６ｈ后 (图１Ｂ)示 :Ｔ波幅度降低 ,ａＶＦ出现Ｑ波 ,Ⅱ及Ｖ７～Ｖ９Ｑ波逐渐加深。心肌酶谱２０８４ｎｍｏｌｓ-１／Ｌ …     

脑梗死心电图酷似急性无Q波心肌梗死1例

患者女,78岁。因鼻出血1天就诊,无高血压、冠心病史。门诊常规心电图(附图上)V_3—V_5呈qrS型,其后ST段弓背向上型抬高0.15—0.3mV,T波倒置,提示急性前壁心肌梗死。收入CCU病房。体检无特殊发现。入院后即按急性心肌梗死处理,但实验室检查心肌酶谱(LDH、CK、CK-MB、AST、a-HBDH)、血沉、血常规及血清钾、钠、氯均在正常范围。第2天     

从新西兰兔心肌坏死前后病理性Q波的变迁看Q波的形成

目的：从新西兰兔心肌坏死动物模型复制前后Q波在体表位置的变迁，探讨病理性Q波的形成原因。方法：30只新西兰兔采用Wilson导联记录其胸背部预定点的心电图，与经定量化学损伤法复制的高前壁心同坏死动物模型相同体表测试点记录的心电图进行比较。统计相关点出现病理性Q波的倒数。结果：在坏死区域正对的体表部位出现了病理性Q波，而对应区域的病理Q波消失。经配对计数资料的x^2检验，P＜0．05，有显性差异。结论：病理性Q波可能是负性的心室腔电位通过该坏死“窗口”传到体表形成的。     

无Q波心肌梗死心电图诊断与临床

本文总结了 63例无Ｑ波心肌梗死(ＮＱＭＩ)的心电图表现与临床特点 ,并与有Ｑ波心肌梗死 (ＱＭＩ)患者做了比较 ,旨在探讨其发生机理及临床意义。1　资料与方法1987年～ 1998年住院的急性ＮＱＭＩ63例 ,其中男 45例 ,女 18例 ,年龄 2 5～84(平均 47.6)岁。并与同期住院的急性ＱＭＩ 174例作对照 ,ＱＭＩ组中男 12 6例 ,女 48例 ,年龄 3 6～ 78(平均 5 8.4)岁 ,急性ＮＱＭＩ患者占同期急性ＡＭＩ住院患者总数的 2 6.5 %。每日常规 12导联ＥＣＧ(至少有 1次18导联 ) ,胸疼发作随时描记 ,症状缓解复查ＥＣＧ ,以观察图形变化。连续 3ｄ检测心肌…     

70岁以上老年人急性心肌梗死临床特点

目的探讨年龄因素对急性心肌梗死（ＡＭＩ）疾病过程及预后的影响。方法将１９～９６岁４８８例ＡＭＩ住院患者按年龄分组，从发病特点、诱发因素、临床过程及疾病转归等方面进行对比。结果随年龄增长，≥７０岁组女性患者的比率明显增高；≥７０岁组发病与慢性心肌缺血史、高血压、糖尿病明显有关，起病时多无典型胸痛，仅表现为呼吸困难、胃肠道反应、意识障碍等症状，出现心律失常、心力衰竭、心源性休克等并发症及病死率均明显高于１９～５９岁及６０～６９岁两组。结论年龄因素是决定老年ＡＭＩ患者预后的重要指标之一。     

Reperfusion strategy for acute myocardial infarction in elderly patients aged 75 to 80 years

The increasing elderly population will influence the treatment policies adopted in cases of acute myocardial infarction. Considering reperfusion therapy in elderly patients with acute myocardial infarction, we compared three strategies, as follows: primary percutaneous coronary intervention (primary PCI: n = 26), facilitated PCI with half the standard dose of mutant tissue-type plasminogen activator (t-PA) (half + PCI: n = 24), and facilitated PCI with a standard dose of mutant t-PA (standard + PCI: n = 15) between patients 75 and 80 years of age. The rate of acquisition of thrombolysis in myocardial infarction (TIMI-3) flow on initial coronary arteriography was significantly lower in the primary PCI group than in the other two groups (7.7% in the primary PCI group vs 60% in the half + PCI and 66.7% in the standard + PCI group). The incidence of hemorrhagic complications including blood transfusion was not significantly different between primary PCI and facilitated PCI. Considering reperfusion therapy in elderly patients with acute myocardial infarction, we concluded that facilitated PCI may be effective in elderly patients aged 75–80 years.     

70岁以上急性心肌梗死病人溶栓疗效的临床观察

目的 探讨溶栓治疗对≥70岁AMI病人的临床意义。方法 将所有AMI病人按年龄分为两组,≥70岁组(132例)和<70岁组(156例)。所有病人随机静脉给予尿激酶或rt-PA,观察其血管再通率、出血并发症、病死率及各种合并症。结果≥70岁组静脉溶栓治疗后120min血管再通率为70.5％,<70岁组为74.4％,两组差异无统计学意义(P<0.05);≥70岁组与<70岁组出血并发症分别为28.8％和25％,脑出血为1.5％和0.6％,两组差异无统计学意义(P相似文献   

直接经皮冠状动脉介入治疗对75岁及以上急性心肌梗死患者心室重构的远期影响

目的 研究直接经皮冠状动脉介入(PCI)治疗对年龄≥75岁的急性心肌梗死(AMI)患者心室慢性重构的影响. 方法 108例患者,PCI组在发病后12h内完成,非PCI组患者给予常规药物保守治疗,随访0.5～8.0年,随访时评估纽约心脏病学会(NYHA)心功能分级并进行超声心动图检查. 结果 106例完成随访,随访中有2例死亡,均为未行PCI治疗的女性患者,1例死于心源性猝死,另1例死于重症肺炎.与非PCI组比较,PCI组NYHA心功能分级低(t=3.17,P＜0.05),左心室收缩末及舒张末容积较小(t值分别为3.50、3.90,均P＜0.01),而左心室射血分数较大(t=2.00,P＜0.05),室壁运动指数较小(t=2.96,P＜0.01);且PCI组E/A比值较大(t=4.04,P＜0.01),E峰减速时间较短(t=4.29,P＜0.01),同时左心室质量指数较小(t=4.7.0,P＜0.01);PCI组左心室长轴直径、短轴直径较短(￡值分别为2.30、5.53,均P＜0.01),球形指数大(t=2.97,P＜0.01). 结论 直接PCI治疗改善了高龄AMI患者慢性心室重构,有助于远期心功能的改善.     

六例老年人右室心肌梗死临床与病理分析

目的探讨老年人右室心肌梗死（ＲＶＭＩ）临床表现和病理解剖的特点。方法分析５１例因急性心肌梗死而死亡经尸检的老年患者中６例合并ＲＶＭＩ的临床病理资料。结果ＲＶＭＩ发生率为１１．８％，右胸前导联心电图对早期诊断ＲＶＭＩ有价值。６例中４例伴发于大面积、多部位的左室梗死，且均见左室下壁梗死；冠状动脉病变多在左冠脉前降支及右冠脉。３例发生心脏破裂。结论老年人ＲＶＭＩ有不同于左室梗死的特点，临床上应高度重视。     

老年冠心病患者无症状心肌缺血的临床研究

目的 :探讨老年冠心病患者无症状性心肌缺血 （SMI）的临床特点和发生规律。方法 :对 2 5 6例老年冠心病患者行 2 4 h动态心电图检测 ,检出心肌缺血 16 7例 ,按临床情况分为 3组 : 组 :单纯 SMI; 组 :有心绞痛史的患者 ; 组 :心肌梗死后患者。结果 :SMI的发生明显高于有症状性心肌缺血 ,占 84 .3% ,发作时间主要是白天 ,以上午 6～ 12点发作最频 ,0～ 6点最少。 , , 组的心肌缺血程度 （SMI发作次数 ,缺血持续时间 ,ST段压低幅度 ）及室性心律失常发生率依次增加 ,而 SDNN和 HRVI依次递减。结果表明 ,心肌缺血程度与室早发生率呈正相关 ,与SDNN,r MSSD,PMN50 及 HRVI呈负相关。结论 :SMI是老年冠心病最常见的表现形式 ,应引起足够重视。冠心病患者心脏自主神经受损程度随着心肌缺血程度而加重     

Vascular access outcome in patients aged over 75 years

We report a retrospective study on the results of 132 native fistulas, 12 grafts and 27 tunneled catheters followed during 30 months in 144 patients on hemodialysis. The results were compared according to patient age: 75 years or over (n = 58, 80.3 +/- 3.5) vs below 75 years (n = 86, 59.5 +/- 13.3). Gender, presence of diabetes and type of fistula were also included in the analysis. RESULTS: There were no statistically significant differences between both groups in the use of tunneled catheters or grafts (8.6% vs 5.8% y 5.2% vs 10.5% respectively), primary failure of native fistulas (7.1% in those aged 75 years or over vs 25.5% in patients below 75 years), rate of thrombosis (0.03 vs 0.09/patient year at risk respectively) or number of percutaneous or surgical procedures in order to maintain the fistula patency (0.11 vs 0.16/patient year at risk respectively). At the same time no differences were seen in the primary, primary assisted and secondary patency of the native fistulas. The mean age of the patients when the first access fistula was created was different according to the area of surgery (74.9 +/- 9.3 for the elbow vs 64.9 +/- 16.2 years for the forearm, p < 0.005). Diabetes was an unfavourable factor for primary (HR Cox 2.08, p < 0.05) or secondary (Log Rank, p <0.05) patency. CONCLUSION: The vascular access for hemodialysis in elderly patients presents a similar evolution to that seen in younger populations if the access creation is based on an exhaustive study, including ecodoppler of the vascular map and the use of more proximal fistulas if necessary. Therefore the more frequent use of grafts or catheters in elderly patients is not justified.     

75岁以上急性心肌梗死患者的临床特征

目的:了解执行《心肌梗死全球统一定义》后,75岁以上高龄急性心肌梗死(acute myocar-dial infarction,AMI)患者的临床特征。方法:入选2009年7月至2011年8月在我院心内科冠心病监护病房住院的老年AMI患者563例,年龄≥75岁的患者作为高龄组,65～74岁的患者作为对照组(非高龄老年组)。回顾性分析两组患者的一般情况、吸烟、心脑血管疾病史、主要症状与体征、生化、心电图、超声心动图结果、主要治疗、合并疾病、并发症、院内不良事件等临床资料和随访情况,并进行比较。结果:与对照组比较,高龄组女性、既往有心绞痛和心肌梗死及脑血管病史、无典型胸痛症状、非ST段抬高心肌梗死(NSTEMI)的比例较高(P<0.05);院前延误时间较长(P<0.01);而舒张压、低密度脂蛋白胆固醇、肌酸激酶同工酶(CK-MB)峰值、左心室射血分数较低;接受血运重建、RAS抑制剂治疗的比例较低(P<0.05),合并疾病、并发症、院内不良事件发生率和病死率更高(P<0.05)。在高龄组中,男性比女性吸烟率较高(P<0.05),接受血运重建率也有增高的趋势(P=0.0682)。随访发现两组患者院外坚持服用阿司匹林、β受体阻滞剂、β受体阻滞剂、肾素血管紧张素抑制剂(RAS)、他汀类调脂药物的百分率均较住院时显著下降(P<0.05),而高龄组比对照组坚持服药率更低(P<0.05);高龄组较对照组院外病死率、再住院率更高(P<0.05)。结论:与非高龄老年组比较,高龄组AMI患者一般情况较差,合并疾病和并发症较多;女性、NSTEMI的比例较高;症状不典型、就诊较晚;较少接受充分治疗,预后较差。     

Management of myocardial infarction in patients over 75 years of age from 1983 to 1999

Elderly patients are often excluded from therapeutic methods which have been shown to improve the prognosis of myocardial infarction (MI). The aim of this study was to describe the changes in management of MI in the elderly and to analyse the factors associated with hospital mortality due to MI during this period. All cases of acute MI in patients over 75 years of age from 1983 to 1999 and admitted to the Centre Hospitalier du Val d'Ariège were reviewed. The clinical features, the modalities of initial management and their treatment on discharge were compared by periods: 1983-88, 1989-93 and 1994-99. The changes in hospital mortality and the factors associated with this mortality were studied. Five hundred and forty-four cases of patients with an average age of 81 years were reviewed. The proportion of patients who were treated medically alone decreased over the 3 periods whereas treatment by angioplasty and thrombolysis increased (1.2% in 1983-88 versus 18.2% in 1994-99). Betablockers, ACE inhibitors and aspirin were much more prescribed on discharge from hospital. In parallel, the hospital mortality from MI decreased by half (50.8% in 1983-88 versus 24.9% in 1994-99). The independent factors associated with hospital mortality were age, anterior infarction (OR = 2.08 [1.39-3.13]), revascularisation of the culprit artery by thrombolysis or angioplasty (OR = 0.24 [0.09-0.61]) and the period of hospital stay (OR = 0.22 [0.12-0.38] in 1994-99 compared with 1983-88). The authors' experience reflects an improved prognosis of MI in the elderly partially due to the benefits of treatment by angioplasty and thrombolysis. Improvement of pre-hospital treatment, better diagnostic methods and more aggressive management of the elderly with MI also contribute to these results.     

Short physical performance battery discriminates clinical outcomes in hospitalized patients aged 75 years and over

AimLow physical function is associated with poor outcomes in hospitalized patients; however, little is known about vulnerable populations such as those aged ≥ 75 years. We examined whether the Short Physical Performance Battery (SPPB) was associated with clinical outcomes in hospitalized patients aged ≥ 75 years.MethodsIn total, 147 patients aged ≥ 75 years (mean age, 86.5 ± 4.7 years; 89 males) completed the SPPB and Mini-Mental State Examination (MMSE) before hospital discharge. Patients were divided into three groups by SPPB score: 0 (unable to perform SPPB), 1–6 (low performance), and 7–12 (high performance). The first occurrence of all-cause unplanned readmission or all-cause mortality within 1 year after discharge was set as the endpoint.ResultsThe median SPPB score of the study population was 2; 41 % were unable to perform SPPB, 33 % had low performance, and 26 % had high performance. High SPPB was associated with younger age, higher body weight, and higher MMSE score. During the follow-up period, 35 (23.8 %) patients were readmitted to hospital and 19 (12.9 %) died. Even after adjusting for covariates, SPPB score was a significant and independent predictor of poor outcomes (hazard ratio for 1 point increase in SPPB, 0.88; P = .002). The subgroup analysis showed SPPB was inversely associated with the occurrence of poor outcomes in patients with cognitive impairment.ConclusionsSPPB is inversely associated with risks for readmission and mortality in hospitalized patients aged ≥ 75 years, especially those with cognitive impairment. The present results indicate the SPPB is useful for accurate prognosis in hospital settings.