1165例急性心肌梗死患者诊疗现状回顾性分析

目的:分析近10年北京安贞医院急性心肌梗死(AMI)患者治疗现状,评价AMI患者不同治疗方式变化趋势及其疗效。方法:1993年至2001年接诊的AMI患者1165例的临床诊治资料和819例随访结果,评价不同治疗方式对患者远期预后的影响以及AMI二级预防治疗现状。结果:1·吸烟患者在本组资料中占54%,高血压病患者占47·7%,糖尿病患者占14·2%,超过50%的就诊患者既往无心绞痛病史;2·约50%患者就诊时间>12h,从而丧失再灌注治疗的最佳时机;3·接受经皮冠状动脉腔内介入术(PCI)治疗的患者逐年增加;4·40%的患者能坚持接受正规系统的随访诊治,61·4%的患者戒烟,71·6%患者改变不健康饮食习惯。结论:对于冠心病一、二级预防工作还有很大的提升空间;接受PCI治疗的AMI患者逐年增加,与患者对PCI的了解和接受程度的增加及我院介入医生梯队的逐年成熟有关;50%就诊时间>12h的患者丧失了再灌注治疗的最佳时机;印证了再灌注治疗在AMI患者中的作用,为制订我国关于AMI指南提供循证依据;加大对AMI患者心血管病危险因素防治的宣传教育。

Retrospective analysis of current therapeutic status on 1165 patients with acute myocardial infarction

Objective:To analyze the current therapeutic status of AMI patients in recent 10 years in Beijing Anzhen hospital.Method:The database was calleotedin 1165 inpatient and 819 follow-up cases of AMI from si ngle clinical center (Beijing Anzhen Hospital). Assessed the impact of different treatments and second prevention on the prognosis of AMI.Result:Patients with smoking were about 54%, hypertensive subjects 47.7% and diabetic subjects 14.2%. More than 50% of all AMI patients complained without angina. Around half of patients delayed their emergency time beyond 12 hours so that they missed the optimal time for revascularization and thus further affect their prognosis. The increased number of PCI could be attributable to the extent of patients' preferences of PCI and the team mature curve in our hospital. The percentage of emergency CABG was low compared with the similar data published. Killip Ⅳ (OR=9.8) and ventricular tachycardia and fibrillation (OR=19.5) were the strong predictor for mortality.Conclusion:The follow-up results showed that there is still big space for cardiovascular risk education. Only 41.7% patient could insist on the formal and regular follow-up. 40.8% patients quitted the smoking. 71.6% patients changed the unhealthy food menu. Half patients took the formal and regular medications. The second prevention for hypertension and hyperlipidemia were acceptable and that of diabetes mellitus needed to be improved.