急性左心衰竭为主要表现的急性心肌梗死的临床特点及预后影响因素分析

目的探讨以急性左心衰竭为主要表现的老年人急性心肌梗死（AMI）的临床特点和预后的主要影响因素。方法回顾性分析96例以急性左心衰竭为主要表现的AMI老年患者的临床资料，其临床特点和预后影响因素。结果96例中有72例（75．0％）为无痛性梗死；76例（79．2％）为急性非透壁性梗死，12例并发完全性左束支传导阻滞；超声心动图LVEF〈40％的有32例，半年内死亡30例（31．25％）。Logistic回归分析表明：高血压（OR=1．157）、严重室性心律失常（OR=4．135），休克（OR=5．256），广泛前壁合并侧壁心梗（OR=1．932）、下壁，后壁，右室心梗（OR=1．853）是预后的危险因素，而急诊介入治疗是保护因素（OR=0．318）。结论以急性左心衰竭为主要表现的AMI病情重，死亡率高，其预后主要受并发症，心律失常、梗死的位置和治疗方法的影响。

Analysis of the clinical characters and related affecting factors influencing early prognosis in the patients with acute left ventricular failure as the main performance of acute myocardial infarction

Objective To explore the clinical characters and the affecting factors of early prognosis in the patients with acute left ventricular failure as the main performance of acute myocardial infarction (AMI). Methods The data collected from 96 cases of the elderly beyond 60 years old with acute left ventricular failure as the main performance of AMI, analyzed the clinical features and the affecting factors of early prognosis. Re-sults Among the surveyed 96 patients, 72 patients (75.0%) were painless miocardial infarction, 76 patients (79. 2%)were Acute non-transmural infarction, 12 patients were complicated by complete left bundle branch block;There were 32 cases of patients with echocardiography LVEF less than 40% ,30 patients (31.25%)died within six months. Multiple logistic regression analysis discovered that hypertension,Serious ventricular arrhyth-mia, Combined extensive anterior wall myocardial infarction, Myocardial infarction at inferior, Posterior wall and The right ventricle were the risk factors for AMI,whose relative risks were 1. 157,4. 135,5. 256,1. 932,1. 853 and 0. 318 respectively. Conclusion The mortality rate of acute left ventricular failure as the main performance of AMI are high. Complications, arrhythmia, the location of myocardial infarction and the treatment are the risk factors influencing the early prognosis and aged patients with AMI.