急性心肌梗死及梗死后心衰患者胱抑素C测定的临床意义

目的 探讨急性心肌梗死（AMI）患者及AMI后心衰患者血清Cys C的水平变化情况及其在临床上的应用.方法 选取住院患者133例为研究对象,其中AMI患者61例,AMI后心衰患者72例,67例健康体检者作为对照组.用乳胶增强免疫比浊法检测Cys C,同时检测血清肌酐（Cr）、血尿素氮（BUN）、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）及肌钙蛋白（cTnI）和脑钠肽（BNP）等指标,并对检测结果进行统计学分析.结果 Cys C,BUN和Cr在对照组、AMI组和AMI后心衰组组间比较差异有统计学意义（F=16.80-19.68,P＜0.05）;AMI组cTnI水平低于AMI后心衰组（t=2.53,P＜0.05）;AMI组Cys C与BUN,Cr,血管病变支数有相关性（r=0.29-0.72,P＜0.05）;AMI后心衰组Cys C与BUN,Cr,病变支数,cTnI有相关性（r=0.49-0.88,P＜0.05）.AMI组Cys C的ROC曲线下面积0.753（P＜0.05）,AMI后心衰组曲线下面积为0.786（P＜0.05）.结论 Cys C在AMI及AMI后心衰患者中都有所升高,且Cys C增高程度与患者的疾病严重程度及预后有关,Cys C在AMI疾病诊断及预后中有一定的价值.     

急性心肌梗死患者血清总同型半胱氨酸、B型利钠肽及C反应蛋白水平的变化

目的 探讨急性心肌梗死（AMI）患者血清总同型半胱氨酸tHcy）、B型利钠肽（BNP）和C反应蛋白（CRP）水平的变化.方法 收集该院AMI患者50例作为AMI组,将同期体检提示为健康的正常人50例作为对照组.AMI组患者在接受溶栓治疗前检测血清tHcy、BNP;分别于发生AMI后2、24、48、72 h检测血清CRP水平.对照组健康者于同期检测上述指标.将tHcy〉16.0 μmol/L,BNP〉35.0 ng/L,CRP〉0.6 g/L作为异常结果.结果 AMI组患者血清BNP、tHcy分别为（45.6±10.5）ng/L、（19.0±5.5）μmol/L;对照组健康者血清BNP、tHcy分别为（10.6±5.2）ng/L、（8.3±3.3）μmol/L.ANI组患者BNP与tHcy水平显著高于正常组（P＜0.05）.AMI组患者发生AMI后2、24、48、72 h的血清CRP水平分别为（0.6±0.3）、（3.5±1.0）、（6.0±1.5）、（2.0±0.5）g/L,对照组健康者血清CRP水平为（0.3±0.3）g/L.AMI组患者发生AMI后各时间点血清CRP水平均高于对照组（P＜0.05）.结论 CRP可作为AMI病情严重程度及变化的重要指标,BNP、Hcy同时异常升高可作为AMI病情判断的重要指标.     

AMI患者QTd、Tp-e和Tp-e／QT的临床意义

目的：探讨AMI患者QT离散度（QTd）、T波峰末间期（Tp-e）和Tp-e/QT的临床意义。方法AMI 患者（AMI 组）和健康成人（对照组）100名,AMI 患者又分室性心律失常组（38例）和无室性心律失常组（62例）,对比分析AMI组和对照组及有、无室性心律失常组的QTd、Tp-e和Tp-e/QT。结果AMI 组的 Tp-e、Tp-e/QT 明显高于对照组,差异均有统计学意义（P ＜0．05）;AMI患者中室性心律失常组Tp-e、Tp-e/QT均明显高于无室性心律失常组,差异均有统计学意义（P＜0．05）;QTd在各组间差异均无统计学意义（P＞0．05）。结论AMI患者Tp-e、Tp-e/QT比健康对照组延长,且与室性心律失常的发生有密切关系。     

心型脂肪酸结合蛋白在急性心肌梗死患者早期诊断中的应用价值

目的: 探讨血清心型脂肪酸结合蛋白（heart-type fatty acid-binding protein,H-FABP）在急性心肌梗死（acute myocardial infarction,AMI）早期诊断中的应用价值。方法: 应用乳胶凝集法检测105例因胸痛疑似AMI就诊患者的血清H-FABP,同时测定患者血清中肌酸激酶同工酶MB（creatine kinase isoenzyme MB,CK-MB）、肌红蛋白（myoglobin, MYO）和心肌钙蛋白I（cardiac troponinc I,cTnI）。根据最终的临床诊断将患者分为AMI组和非AMI组（对照组）,并对2组检测结果的阳性率、诊断效率等进行分析比较。结果: 105例疑似AMI患者中,最终诊断为AMI患者45例,其余60例排除AMI诊断作为对照组。AMI组的H-FABP、cTnI、MYO、CK-MB平均水平及阳性率分别为（49.32±10.29） ng/mL、84.4%,（1.62±0.76） ng/mL、44.4%,（156.14±54.23） ng/mL、82.2%,（13.01±6.08） ng/mL、42.2%,均高于对照组（P<0.05）;AMI组中H-FABP阳性率与MYO阳性率间无统计学差异（P>0.05）,但明显高于cTnI及CK-MB的阳性率（P<0.05）。H-FABP与CK-MB诊断AMI的特异度相似（P>0.05）,但低于cTnI（P<0.05）,高于MYO（P<0.05）。H-FABP与cTnI的阳性预测值相似（P>0.05）,均高于MYO、CK-MB（P<0.05）。在阴性预测值方面,H-FABP与MYO相似（P>0.05）,明显高于cTnI和CK-MB（P<0.05）。4项指标检测结果进行组合分析,H-FABP+ cTnI、H-FABP+ CK-MB、H-FABP+ MYO、H-FABP+ cTnI+MYO、H-FABP+ cTnI+CK-MB、H-FABP+ cTnI+MYO+CK-MB诊断AMI的灵敏度均为100.0%,特异度分别为82.0%、72.0%、61.2%、59.3%、68.1%和56.5%。结论: H-FABP在AMI早期诊断中具有较好的灵敏度和特异度,与cTnI联合检测,可显著提高AMI早期诊断效能。     

急性心肌梗塞患者QT离散度的变异及其对预后的影响

对61例急性心肌梗塞（AMI）死亡患者的QT离散度（QTd）进行了测定，并与60名AMI存活患者和60名正常人进行对比研究，结果显示，AMI患者的QTd、QTcd、JTd、JTcd显著增加高于正常人（P＜0.01）。AMI死亡者亦明显高于存活者（P＜0.05），且AMI死于室额的患者QTd显著增高。结果提示QTd的增高对判断AMI的预后有重要意义。     

窦性心率震荡在急性心肌梗死患者中的变化

目的：研究窦性心率震荡（HRT）在急性心肌梗死（AMI）患者中的变化。方法：选择发病1~3周的92例AMI患者和70例年龄、性别相匹配的健康体检者分别作为AMI组和对照组,收集入选患者详细临床资料。所有患者行24 h动态心电图（Holter）检查,获取心率变异性时域指标（SDNN）、平均心率以及HRT的3个参数,即震荡斜率起始时间（TT）、震荡初始（TO）和震荡斜率（TS）。结果：AMI患者HRT现象明显减弱,TT、TO高于对照组,TS值低于对照组（P〈0.05）。结论：HRT在AMI组和对照组之间差异有显著性,尤以TT和TS差异显著,HRT可作为AMI后再发心脏事件的有效预测因子。     

急性心肌梗死时心电图对应导联ST段压低的临床价值分析

目的 探讨急性心肌梗死（AMI）伴或不伴ST段压低（STD）临床意义.方法 纳入2009年9月到2012年9月AMI患者65例,其中AMI伴STD患者（STD组）29例,不伴STD患者（NSTD组）36例.分析两组患者冠脉受累支数、心肌损伤标志物水平及体内炎症水平差异.结果 STD组患者更多罹患冠脉多支病变;AMI伴STD患者心肌损伤标志物水平较NSTD患者高;同时,AMI伴STD患者红细胞沉降率（ESR）及C反应蛋白（CRP）水平均较NSTD患者为高.结论 AMI伴STD发生率高,可能提示更严重心肌病变及更强烈炎症反应.     

血浆同型半胱氨酸与B型尿钠肽对急性心肌梗死的诊断和预后价值

目的：探讨血浆同型半胱氨酸（Hcy）和B型尿钠肽（BNP）联合检测对急性心肌梗死（AMI）的诊断和预后价值。方法选取140例AMI患者（AMI组）及125例健康人（对照组）,分别检测其血浆Hcy和BNP水平,并对结果进行分析。结果治疗前,AMI组血浆BNP[（585．24±155．37）pg/mL]和Hcy[（33．4±9．84）μmol/L]水平明显升高,与对照组比较差异有统计学意义（P＜0．05）。AMI患者经治疗后血浆BNP和Hcy水平显著降低,与治疗前比较差异有统计学意义（P＜0．05）。在随访期间,发生心血管事件的AMI患者血浆BNP和Hcy水平明显高于未发生心血管事件的AMI患者,差异具有统计学意义（P＜0．05）。结论BNP和Hcy可作为指导临床诊断和治疗AMI的重要指标,并可作为预测AMI患者远期康复的重要参数。     

168例急性心肌梗死患者血磷监测分析

目的探讨血磷水平监测在急性心肌梗死（AMI）患者中的临床应用价值。方法酶法检测168例确诊为AMI住院患者的血清钙、磷含量。45例门诊体检健康者作为对照。结果（1）AMI组与健康对照组血磷含量差异有统计学意义（P〈0．01）,血钙水平差异无统计学意义（P〉0．05）。（2）AMI低磷血症组（67例）和血磷正常组（101例）死亡病例分别为8例（11．94％）和11例（10．89％）,差异无统计学意义（P〉0．05）。但低磷血症组患者经补磷治疗后,血磷纠正组存活率比血磷未纠正组明显上升,差异有统计学意义（P〈0．01）。结论AMI患者常伴有低磷血症,低磷可反映AMI患者心肌受损的严重程度,并与AMI患者死亡有关。动态监测血磷水平,便于临床医生了解病情,及时进行补磷治疗,提高AMI患者的抢救成功率。     

阿司匹林抵抗对急性心肌梗死的发生及再发的预测价值

目的探讨阿司匹林抵抗对急性心肌梗死（AMD的发生及AMI患者再发心肌梗死的预测价值。方法选择113例冠心病（CHD）患者和104例AMI患者,CHD患者入选后抽空腹外周静脉血2．7rnl,AMI患者冠状动脉介入术后第7天停用肝素后抽空腹外周静脉血2．7ml,检测血小板聚集率（PAG）判断阿司匹林抵抗（AR）或非阿司匹林抵抗（NAR）,并依此分组,随访18个月观察CI-ID患者发生AMI和AMI患者再发心肌梗死情况。结果CHD患者43例为AR（38．05％）,AMI患者38例为AR（36．54％）,高血压是CHD患者AR的主要影响因素（RO=2．263,P〈0．05）,血小板计数是AMI患者AR的主要影响因素（RO=2．342,P〈0．05）。随访18个月CHD患者AR组和NAR组随访率为95．35％和92．86％,AR组和NAR组AMI发生率为12．20％和6．15％,差异有统计学意义（AR组w．NAR组,矿=5．247,OR=1．984,P〈0．05）。AMI患者AR组和NAR组随访率为94．73％和93．94％,AR组和NAR组再发率为13．89％和3．23％,差异有统计学意义（AR组w．NAR组,X2=8．394,OR=4．300,P〈0．01）。AR是CHD患者发生AMI的独立危险因素（OR=5．218,P〈0．05）,AR是AMI患者再发心肌梗死的独立危险因素（OR=6．128,P〈O．05）。结论高血压和血小板计数与未发生心脑血管事件的CHD患者和AMI患者AR密切相关,AR与CHD患者和AMI患者预后有关,可以作为预测CHD患者发生AMI和AMI患者再发的预测因素。     

河北省缺血性脑卒中院内诊治时间分布研究

目的:调查河北省急性缺血性脑卒中患者的院内诊治时间分布情况。方法:收集并分析河北省急性缺血性脑卒中患者的院内诊治流程资料并与NINDS推荐时间进行比较。结果:院内诊治中位时间104 min高于推荐的60 min（ P<0.001）;"完成头颅CT扫描-获取CT报告"中位时间30 min高于推荐的20 min（ P<0.001）;"获取头颅CT报告-开始治疗"中位时间43 min高于推荐的15 min（ P<0.001）。通过EMS就诊患者院内诊治中位时间是101 min,低于未采用患者的104 min（ P=0.01）;三级医院院内诊治中位时间是105 min,迟于二级医院的99 min （ P<0.05）。 结论:河北省急性缺血性脑卒中院内救治延迟现象严重。获取头颅CT报告到开始溶栓治疗这一环节是造成院内延迟的最主要环节。通过EMS就诊可以缩短院内救治时间;二级医院相比三级医院院内延迟情况较轻。     

Comparison of children receiving emergent sepsis care by mode of arrival

ObjectiveTo determine if differences in patient characteristics, treatments, and outcomes exist between children with sepsis who arrive by emergency medical services (EMS) versus their own mode of transport (self-transport).MethodsRetrospective cohort study of patients who presented to the Emergency Department (ED) of two large children's hospitals and treated for sepsis from November 2013 to June 2017. Presentation, ED treatment, and outcomes, primarily time to first bolus and first parental antibiotic, were compared between those transported via EMS versus patients who were self-transported.ResultsOf the 1813 children treated in the ED for sepsis, 1452 were self-transported and 361 were transported via EMS. The EMS group were more frequently male, of black race, and publicly insured than the self-transport group. The EMS group was more likely to have a critical triage category, receive initial care in the resuscitation suite (51.9 vs. 22%), have hypotension at ED presentation (14.4 vs. 5.4%), lactate >2.0 mmol/L (60.6 vs. 40.8%), vasoactive agents initiated in the ED (8.9 vs. 4.9%), and to be intubated in the ED (14.4 vs. 2.8%). The median time to first IV fluid bolus was faster in the EMS group (36 vs. 57 min). Using Cox LASSO to adjust for potential covariates, time to fluids remained faster for the EMS group (HR 1.26, 95% CI 1.12, 1.42). Time to antibiotics, ICU LOS, 3- or 30-day mortality rates did not differ, yet median hospital LOS was significantly longer in those transported by EMS versus self-transported (6.5 vs. 5.3 days).ConclusionsChildren with sepsis transported by EMS are a sicker population of children than those self-transported on arrival and had longer hospital stays. EMS transport was associated with earlier in-hospital fluid resuscitation but no difference in time to first antibiotic. Improved prehospital recognition and care is needed to promote adherence to both prehospital and hospital-based sepsis resuscitation benchmarks.     

不同性别急性ST段抬高型心肌梗死患者临床特征及住院期间预后分析

目的总结不同性别急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction, STEMI)患者的临床特征、治疗方案及住院期间转归。方法回顾性分析1 686例(男1 224例,女462例)STEMI患者的临床资料。结果女性STEMI患者年龄[70.43(63.69,76.39)岁]较男性[61.21(50.90,70.22)岁]大,吸烟比率(3.03%)较男性(55.07%)低,前壁心肌梗死比率(60.17%)、合并心律失常比率(23.16%)、心率>100次/min比率(12.99%)及合并高血压、高胆固醇血症、糖尿病比率(56.71%、12.34%、22.08%)较男性(55.07%、17.08%、8.91%、43.06%、6.78%、13.81%)高(P<0.05)。女性患者保守治疗比率(57.36%)较男性(37.75%)高,溶栓治疗、择期行经皮冠状动脉介入术、发病12 h内再灌注治疗比率(20.35%、17.10%、27.27%)较男性(30.23%、24.92%、43.14%)低(P<0.05),入院至球囊扩张时间、入院至溶栓药物注射时间、发病至首次医疗接触时间等与男性比较差异无统计学意义(P>0.05)。女性患者住院期间病死率(6.28%)及不良心脑血管事件发生率(13.85%)均高于男性(2.37%、8.25%)(P<0.05)。广义线性混合模型调整年龄与中心效应后,女性为STEMI患者住院期间死亡(OR=2.32,95%CI:1.30~4.14,P=0.004)、发生不良心脑血管事件的独立危险因素(OR=1.76,95%CI:1.25~2.47,P=0.024)。结论与男性患者比较,女性STEMI患者住院病死率及不良心脑血管事件发生率较高,可能与年龄较大、合并较多的心血管疾病高危因素、多采取保守治疗有关。     

河北省二三级医院急性ST段抬高型心肌梗死患者早期再灌注治疗现状及预后

目的了解河北省二、三级医院急性ST段抬高型心肌梗死(STEMI)患者早期再灌注治疗现状及预后情况。方法收集河北省二、三级医院经急诊就诊的急性心肌梗死(AMI)患者资料,入选发病12 h内的2010例STEMI患者,分析基线资料、治疗现状及预后情况。结果二、三级医院接受早期再灌注治疗比例占总人数的69.1%,其中接受直接经皮冠状动脉介入治疗(PCI)的患者占53.0%,接受溶栓治疗的患者占16.1%;未行早期再灌注治疗的患者占30.9%。二、三级医院早期再灌注治疗的比例差异无统计学意义(68.8%vs.69.1%,P> 0.05),二级医院以溶栓治疗为主(62.0%vs.9.2%,P <0.001),直接PCI比例较低(6.8%vs.60.0%,P <0.001)。与三级医院比较,二级医院未接受再灌注治疗的原因中存在溶栓禁忌、医院不具备PCI条件比例较高(56.1%vs.10.2%,31.7%vs.2.2%,P均<0.001)。二级医院与三级医院的STEMI患者住院病死率差异无统计学意义(7.6%vs.5.4%,P> 0.05)。二级医院与三级医院三年内随访生存率差异均无统计学意义(94.5%vs.93.1%,90.7%vs.90.6%,87.4%vs.88.5%,P均> 0.05)。二级医院因心源性休克所致死亡比例较三级医院高(5.3%vs.2.5%,P <0.05)。结论河北省二、三级医院急性STEMI患者的再灌注治疗方式仍存在巨大区域差异;与以直接PCI为主的再灌注方式比较,以溶栓为主的再灌注方式具有相同的预后;仍有相当比例的患者未早期接受任何再灌注治疗。     

Costs, clinical outcomes, and health-related quality of life of off-pump vs. on-pump coronary bypass surgery.

BACKGROUND: Off-pump coronary bypass surgery avoids the potential complications of cardiopulmonary bypass. However, its acceptance depends on medical and economic outcome. The aim of this prospective non-randomised study was to compare functional and economic outcome of off-pump and on-pump surgery at 1-year follow-up. METHODS: 102 patients (pts) treated with either off-pump (60pts) or on-pump surgery (42pts) were studied. Pts with left ventricular dysfunction, recent myocardial infarction (<1 month), renal impairment, valve surgery, previous stroke or coagulopathy were excluded. Variable and fixed costs were obtained for each treatment group during operative and postoperative care. In-hospital endpoints included all-cause mortality and complications (defined as excessive bleeding [>6 units blood transfusion], peri-operative myocardial infarction, atrial fibrillation, stroke, and infection). All cause mortality; cost-effectiveness and quality of life were assessed 1 year after surgery. RESULTS: The in-hospital mortality was similar in the two treatment groups. Off-pump group had significantly fewer postoperative complication rate (off-pump 41% vs. on-pump 72%, p=0.001). The mean in-hospital cost was lower for off-pump surgery (off-pump 6.515+/-926 euro vs. on-pump 9.872+/-1.299 euro, p<0.0001) as well as the mean length of hospital stay (off-pump 4.93+/-0.93 days vs. on-pump 6.58+/-1.04 days, p<0.0001). At 1 year, all cause mortality, quality of life indices, return to work rate and treatment satisfaction was similar in both groups. CONCLUSION: Off-pump myocardial revascularization maintains the advantages of conventional surgery in terms of survival and freedom from cardiac events while reducing the in-hospital cost.     

急性心肌梗死6 h内溶栓与延迟溶栓的疗效评价

目的　观察发病后不同时间溶栓对急性心肌梗死 (acute m yocardial infarction,AMI)的疗效。方法　 95例 AMI患者按发病时间分成 <6 h(46例 )和 6～ 12 h(延迟溶栓 4 9例 )两组 ,观察两组患者的血管再通率、病死率及不良反应发生率。结果　 <6 h溶栓组血管再通率为 76 % ,病死率为 4 % ;延迟溶栓组血管再通率为 4 9% ,病死率为 12 % ,两组比较均有统计学差异 (P均 <0 .0 1)。两组不良反应发生率 (15 %比 16 % )无统计学差异 (P>0 .0 5 )。结论　 6 h内溶栓者再通率高 ,病死率低。延迟溶栓仍有较高的血管再通率 ,对有溶栓适应证者也应积极进行溶栓治疗。     

Predictors of survival in unselected patients with acute myocardial infarction requiring continuous catecholamine support

BACKGROUND: Several predictors of survival have been described in selected subgroups of patients suffering from acute myocardial infarction. However, data on unselected patients with acute myocardial infarction and cardiogenic shock, including patients with out-of hospital cardiac arrest, are missing. We aimed to assess predictors of survival for an unselected cohort of patients representative of clinical practice who experienced acute myocardial infarction and required continuous catecholamine support for circulatory failure. METHODS: The study was performed at a 2000 bed university hospital. All consecutive patients admitted to our emergency department with acute myocardial infarction were prospectively enrolled in a clinical trial from 1993 to 2000. DESIGN: A retrospective cohort study was performed on patients with myocardial infarction requiring catecholamine support within the first 24 h. Primary endpoint was in-hospital mortality. RESULTS: The analysis was carried out on 262 patients, 189 men (72%), median age 65 years (IQR 53-73). Out-of-hospital cardiac arrest was reported in 47% (122/262). In-hospital mortality was 53% (138/262). Survivors as compared to non-survivors exhibited significant differences with respect to age (60 vs. 68 years, P<0.0001), systolic and diastolic blood pressure on admission (110 vs. 102 mmHg, P=0.01 and 64 vs. 58 mmHg, P=0.006, respectively), initial blood serum lactate (6.8 vs. 8.3, P=0.01), peak CKMB level (93 vs. 138 U/l, P=0.005), use of adrenaline (epinephrine) (38 vs. 68%, P<0.0001) and any attempt of revascularisation (76 vs. 63%, P=0.03). In a multivariate model younger age [OR 1.06 (CI 1.03-1.10), P<0.001], no use of adrenaline [OR 2.63 (CI 1.35-5.26) P=0.005] and lower peak CKMB [OR 1.01 (CI 1.01-1.01), P<0.0001] were independently associated with in-hospital survival. CONCLUSION: In unselected patients including CPR survivors with acute myocardial infarction requiring continuous catecholamine support, younger age, the absence of continuous adrenaline administration and a lower peak CKMB were independently associated with increased in-hospital survival.     

Successful out-of-hospital cardiopulmonary resuscitation: what is the optimal in-hospital treatment strategy?

The aim of the study was to evaluate prognostic factors in patients after successful out-of-hospital resuscitation (sOHR) within 30 min after admission. A prognostic scoring scale in patients surviving OHR was analysed. We also studied the effect of these predictive factors and the in-hospital treatment (percutaneous transluminal coronary angioplasty (PTCA) vs. thrombolysis) on mortality. We performed a retrospective analysis of the emergency medical system forms and medical files of 72 consecutive patients aged > or =18 years with sOHR. Of these 72 patients 37 (51%) met the electrocardiographic and enzymatic criteria for acute myocardial infarction (AMI). Ten of the 37 AMI patients (27%) underwent acute PTCA as primary treatment and seven patients (19%) received thrombolytic therapy for AMI despite prolonged (mean 24+/-13 min) cardiopulmonary resuscitation (CPR). The remaining 20 patients had no specific infarct treatment. Despite successful PTCA, in eight out of ten patients, their mortality in hospital was 60% (6/10). Mortality in the thrombolysis group was 57% (4/7). For the remaining 20 MI-patients the mortality was 65% (13/20). Univariate and multivariate analyses were performed to design a weighted prognostic scoring system. The Glasgow coma scale (GCS) was the strongest independent predictor (r=0.76, P< or =0.001) for in-hospital death. Conclusions: in-hospital mortality after successful OHR seems to largely depend on neurological status at admission and much less on the specific treatment of myocardial infarction. The prognostic scoring system accurately predicted the in-hospital mortality and can be used for early treatment stratification; however, it should be proven in a prospective study.     

1827例急性心肌梗死患者梗死部位的相关分析

目的　调查不同部位急性心肌梗死患者梗死的发病特点。方法　通过回顾病史 ,将符合诊断标准的住院患者按照不同发病部位分组 ,分别记录发病特点 ,了解不同发病部位的构成比 ,不同发病部位的男女构成比以及发病部位与病死率的关系。结果　符合条件的病例共 182 7例 ,前壁急性心肌梗死 (前壁、前间壁和广泛前壁 )占总发病的 4 5 8% ,其次是下壁急性心肌梗死组占 2 6 7%。在所有部位急性心肌梗死病例中 ,男性发病比例 (6 4 0 %～ 88 3% )与女性 (11 7%～ 36 0 % )相比均有很大差别 (P <0 0 5 )。各部位急性心肌梗死的病死率为 8 7%～ 2 0 6 %。除急性前壁合并下壁组心肌梗死病例病死率差异有显著性外 (P <0 0 5 ) ,其他部位急性心肌梗死患者的病死率与急性心肌梗死平均住院病死率相比差异未见显著性(P >0 0 5 )。结论　急性心肌梗死以前壁或下壁为主 ,男性仍是发生急性心肌梗死的主要人群 ,急性前壁和合并下壁心肌梗死的病死率显著高于急性心肌梗死平均病死率。     

急性ST段抬高型心肌梗死合并血糖代谢异常患者预后分析

目的:总结急性ST段抬高型心肌梗死(STEMI)合并血糖代谢异常(2型糖尿病或就诊血糖升高)患者的预后。方法:回顾性分析2010年1月-2013年9月我科确诊STEMI患者413例的临床资料,比较血糖正常组(A组)与就诊血糖升高组(B组)、2型糖尿病组(C组)的预后。结果:(B+C)组住院期间死亡率明显高于A组(24.7%vs.9.4%,P0.05),C组住院期间再发心肌梗死率明显高于B组和A组(3.9%vs.0%vs.0.7%,P0.05),C组、B组与A组比较,再发心绞痛率(23.4%vs.31.0%vs.14.7%,P0.05)、住院期间心力衰竭率(41.6%vs.50.0%vs.22.1%,P0.05)、住院期间MACE(58.4%vs.65.5%vs.33.4%,P0.05)及一年全因死亡率(34.2%vs.31.4%vs.16.7%,P0.05)发生率更高。结论 :STEMI合并血糖代谢异常的预后差于血糖正常组。