老年危重急性心肌梗死患者机械通气治疗临床转归的多因素分析

目的观察老年危重急性心肌梗死患者行机械通气治疗的疗效,探讨与死亡相关的预测因素。方法回顾分析使用气管插管机械通气治疗的老年危重急性心肌梗死患者41例,观察机械通气治疗的疗效并对影响患者预后的相关因素进行分析。结果41例患者康复出院14例,院内死亡27例(66%)。多因素分析表明,入院时血肌酐升高(肌酐>133μmol/L),左心室射血分数严重减低(左心室射血分数<35%),上呼吸机时血压偏低[收缩压<100mm Hg(1 mm Hg=0.133 kPa)]是增加死亡风险的独立预测因素。结论老年危重急性心肌梗死患者行机械通气治疗死亡率仍然很高;肾功能、心功能是死亡风险的独立预测因素。

Prognosis of complicated acute myocardial infarction treated with mechanical ventilation in elderly patients

Objective To observe the outcome and determine the prognostic factors associated with death in elderly patients with complicated acute myocardial infarction treated with mechanical ventilation.Method Forty-one elderly patients with complicated acute myocardial infarction treated with mechanical ventilation were analyzed retrospectively.Multifactorial logistic regression models to predict outcome were developed using variables available at intubation.Results The total mortality of 41 patients was 66%.Nonsurvivors had increased serum creatinine,decreased LVEF and blood pressure on admission(P<0.05).Mortality was related to serum creatinine >133 μmol/L(OR=15.34,95% CI:1.115-211.140,P=0.0412),LVEF<35%(OR=11.17,95% CI:1.034-120.618,P=0.0468),and systolic blood pressure at intubation <100 mm Hg(OR=21.45,95% CI: 2.060-223.276,P=0.0103).Conclusions Elderly patients with acute myocardial infarction treated with mechanical ventilation had high mortality rate.High serum creatinine,low LVEF and SBP at intubation were predictive factors of mortality.