早发急性心肌梗死患者院内死亡的临床特点分析

目的：探讨早发急性心肌梗死（ AMI）院内死亡患者的临床特点、危险因素及死亡原因，为采取针对性的干预措施提供参考依据。方法回顾性分析2008年1月—2015年4月住院期间死亡的165例AMI患者的一般情况、家族史、既往病史及手术史、入院时检查、临床诊断、及院内死亡情况、死亡原因。根据患者发病及死亡年龄，将患者分为早发死亡组和非早发死亡组。结果（1）早发死亡组家族史比例高于非早发死亡组（P＜0．01）且发病至死亡时间中位数，早发死亡组（2 d）明显低于非早发死亡组（7 d）；（2）早发死亡组低密度脂蛋白胆固醇（LDL）、磷酸肌酸激酶（CPK）峰值、纤维蛋白原（Fib）明显高于非早发死亡组（ P＜0．01，P＜0．05）；（3）与非早发死亡组比较，饮酒、饱食是早发死亡组患者发生AMI的独特诱因（ P＜0．01，P＜0．05）；（4）治疗方案中两组患者无明显差异，但急诊经皮冠状动脉腔内血管成形术（PTCA）、急诊支架植入、溶栓治疗、择期介入治疗所占比例均较小；（5）非早发死亡组下壁心梗较早发死亡组所占比例较大（P＜0．01），早发死亡组心梗部位以前壁、前间壁、广泛前壁为主（24／34，70．59％），非早发死亡组以合并下壁为主（74／131，56．49％）；（6）早发死亡组死亡原因中以心率失常（房室传导阻滞、室速、室颤）为主（24／31，77．42％），非早发死亡组以泵衰竭（包括心力衰竭和心源性休克）为主（55／131，41．98％）。其中早发死亡组死亡原因较非早发死亡组心力衰竭例次较低（P＜0．01），心室颤动例次较高（P＜0．05）。结论早发AMI院内死亡患者多具有遗传因素且较多累及前壁，饮酒、饱食是其独特的发病诱因，致死原因多为室颤。应重视LDL、CPK、Fib对判断预后的价值。

Clinical features of In-hospital death in patients early acute myocardial infarction

Objective To investigate the clinical features, risk factors and the death causes of in-hospital death in patients with early acute myocardial infarction in order to provide reference for the specific intervention measures.Methods Retrospectively analyzed the clinical data during the January 2008 to April 2015 of 165 cases of hospital mortality in patients with AMI.The data included the gener-al condition,family history, medical history and the history of surgery, hospital inspection, clinical diagnosis,treatment, in-hospital death and the reasons.According to the age of onset and death, the patients were divided into premature death group ( pre-death group) and no-premature death group(N-pre death group).Results (1)Family history of pre-death group was higher than N-pre death group(P<0.01),the median time from onset to death of pre-death group(2 d) was lower than that in N-pre death group(7 d). (2)The low density lipoprotein cholesterol (LDL), the creatine phosphate kinase (CPK)peak, fibrinogen (Fib) of pre-death group was significantly higher than N-pre death group (P<0.01, P<0.05).(3)Drinking and satiation was the unique cause of AMI in pre-death group.(4) The treatment regimens were not significantly different among the two groups, but emergency percutaneous coro-nary angioplasty ( PTCA) , emergency percutaneous coronary intervention, thrombolytic therapy and percutaneous coronary intervention were less.(5) The inferior wall myocardial infarction of pre-death group was lower than N-pre death group( P<0.01) .AMI was local-ized in 70.59% anterior, anteroseptal, extensive anteriorpartition wall in pre-death group and 56.49% inferior wall in N-pre death group.(6)The death causes included arrhythmia (atrioventricular block, ventricular tachycardia and ventricular fibrillation) were more frequent in pre-death group(24/31,77.42%),while pump failure (including source of heart failure and heart shock) was much more common in N-pre death group(55/131,41.98%).The ventricular fibrillation in pre-death group was more common than that in N-pre death group(P<0.05),while the heart failure was more frequent in N-pre death group(P<0.01).Conclusion The early AMI in-hospital death patients carried the genetic factors,the most common location was anterior wall.Drinking and satiation were the unique cause.Ventricular fibrillation was the major cause of death.More emphasis should be given to predictors of in-hospital mortality, such as LDL , CPK, Fib.