老年急性心肌梗死并发心源性休克介入与非介入治疗的临床研究

目的 对比分析介入治疗与非介入治疗对年龄＞75岁的老年急性心肌梗死(AMI)并发心源性休克(CS)患者的疗效.方法 回顾性分析我院63例年龄＞75岁的ST段抬高型心肌梗死(STEMI)患者入院时及入院36 h内并发CS的资料,根据是否行PCI分为介入组及非介入组,比较两组基线资料、治疗效果及预后.结果 两组基线资料差异无统计学意义,梗死部位多见于前壁、前侧壁及广泛前壁(85.19%、80.56%),多见于三支血管病变或左主干病变(74.07%、37.04%),且多合并肺部感染(44.44%、55.56%).经过不同治疗后,介入组院内死亡率有所降低(51.85%比77.78%,P＜0.05),心律失常发生率下降(40.74%比69.44%,P＜0.05),血肌酐升高≥50%也明显低于非介入组(33.33%比58.33%,P＜0.05);而肺部炎症发生率(55.56%比75.00%,P＞0.05)、IABP使用率(40.74%比27.78%,P＞0.05)及呼吸机使用率(33.33%比30.56%,P＞0.05)两组差异均无统计学意义.结论 即使是年龄＞75岁的老年AMI并发CS患者,介入治疗仍可获得相对较好的治疗效果,尤其对心律失常和肾功能恶化,可使院内死亡率下降.

Clinical study on invasive and non-invasive treatment of acute myocardial infarction complicated by cardiogenic shock in elderly patients

Objective To compare invasive and non-invasive treatment in elderly patients with acute my- ocardial infarction complicated by cardiogenic shock. Methods Retrospetive analysis of the patients aged 〉75 years with ST elevation myocardial infarction complicated by cardiogenic shock was conducted in our hospital and 63 patients were enrolled. Patients were divided into invasive（PCI） group and non-invasive group. Then we analyze the differences in baseline characteristics effect and prognosis between the two groups. Results There is no obvi- ous difference in baseline characteristics, and area of myocardial infarction is more often in anterior wall, anterolat- eral wall and extensive anterior wall （85.19% and 80.56% ）, and three vessel disease and left main coronary artery （74.07% and 37.04%） are more frequent, and lung infection rate is high（44.44% and 55.56%） in both groups. In invasive group, mortality is lower （51.85% vs 77.78%, 0.010〈P〈0.025）, and arrhythmia incidence is less（40.74% vs 69.44%, 0.010〈P〈0.025） and crcatinine clearance rate impairment （increasing≥50%） is lower （33.33% vs 58.33%, 0.025〈P〈0.050） in invasive group than non-invasive group. But there is no significant difference in pul- monary infection incidence and IABP and breathing machine utilization rate （55.56% vs 75.00%, P〉0.05, 40.74% vs 27.78%, P〉0.05, 33.33% vs 30.56%, P〉0.05 ）. Conclusion Invasive treatment is effective in decreasing oc- currence of arrhythmia and kidney function failure and mortality in patients aged 〉75 years with acute myocardial infarction complicated by cardiogenic shock.