院内发生器官功能衰竭对老年急性心肌梗死患者预后的影响——附2 535例病例分析

目的 比较不同年龄老年急性心肌梗死(AMI)患者住院发生心、肺、肾器官功能衰竭等严重并发症情况及其对近期预后的影响.方法 对2 535例老年AMI住院患者按年龄、住院期间预后分别分组,回顾分析各组并发症的发生率.结果 ①与60～79岁组(老年组)AMI患者相比,≥80岁组(高龄组)住院病死率显著升高(22.75%(326/422)比12.26%(1 854/2 113),X2=42.15,P<0.01].②老年死亡组(259例)并发心源性休克(44.0%)、心功能Killp Ⅱ～Ⅲ级(28.2%)、呼吸衰竭(14.3%)、脑卒中(11.2%)、肾衰竭(11.2%)、心律失常(49.8%)、贫血(14.7%)的发生率均高于存活组(1 854例,分别为27.1%、17.4%、7.5%、4.5%、4.5%、40.3%、9.1%,均P<0.01);两组间消化道出血(5.8%比3.9%)和肺感染(24.7%比20.2%)发生率差异无统计学意义(均P>0.05).高龄死亡组(96例)并发心源性休克(28.1%)、心功能KillpⅡ～Ⅲ级(32.3%)、呼吸衰竭(17.7%)、肾衰竭(16.7%)、消化道出血(10.4%)、心律失常(49.O%)、贫血(21.9%)的发生率均高于存活组(326例,分别为12.9%、21.2%、9.2%、5.2%、2.1%、35.OH、10.1%,P<0.05或P<0.01);两组间脑卒中(11.4%比5.8%)和肺感染(32.3%比23.3%)发生率差异均无统计学意义(均P>0.05).③老年死亡组和存活组患者住院并发症种类前4位均为心律失常、心源性休克、心功能KillpⅡ～Ⅲ级、肺感染;而高龄死亡组和存活组患者住院并发症种类前4位依次为心律失常、肺感染、心功能KillpⅡ～Ⅲ级、心源性休克.高龄死亡组患者住院期间心源性休克发生率低于老年死亡组(28.1%比44.0%,P<0.01),但猝死率显著高于老年死亡组(22.92%比7.34%,P<0.01).结论 高龄AMI患者住院病死率升高,器官功能衰竭发生率明显增多;其中心律失常是老年和高龄AMI患者首要的并发症.对于老年患者,应高度重视心源性休克的发生和救治,而对于高龄AMI患者,更需警惕和预防猝死的发生.

Influence of in-hospital occurrence of organ failure on the prognosis of acute myocardial infarction in the elderly patients: an analysis of 2 535 cases

Objective To investigate the influence of in-hospital occurrence of organ failure on the prognosis of acute myocardial infarction (AMI) in 2 535 elderly patients of different age. Methods A total of 2 535 patients with AMI were divided into different age groups or outcome groups, and the outcome or the incidence of in-hospital complications were reviewed in different groups. Results ①The rate of in-hospital death was higher in≥80 years group (22.75%, 326/422) compared with that in 60 - 79 years group (12.26%, 1 854/2 113, X2= 42. 15, P<0. 01).②Compared with the survivors (1 854 cases, 27.1%,17.4 %, 7.5 %, 4. 5 %, 4.5%, 40. 3 %, 9.1% ), patients who died in hospital (259 cases) were more likely to have cardiogenic shock (44.0%), Killp Ⅱ-Ⅲ heart function (28.2%), respiratory failure (14.3%),stroke (11.2%), renal failure (11.2%), cardiac arrhythmia (49.8%), and anemia (14. 7%) in 60 -79 years group (all P<0. 01). No difference in the rate of pulmonary infection (24.7% vs. 20. 2%) and alimentary tract hemorrhage (5.8% vs. 3.9%) was found between two groups (both P>0. 05). The incidence of cardiogenic shock (28. 1%), Killp Ⅱ -Ⅲ heart function (32.3 %), respiratory failure (17. 7%), renal failure (16.7%), alimentary tract hemorrhage (10. 4%), cardiac arrhythmia (49. 0%) and anemia (21.9%) was higher in non-survival group (96 cases) than that in survival group (326 cases, 12.9%, 21.2%, 9. 2%,5.2%, 2. 1%, 35.0%, 10. 1%, P<0. 05 or P<0. 01) in patients≥80 years. There was no difference in the incidence of stroke (11.4% vs. 5.8%) and pulmonary infection (32.3% vs. 23.3%) between two groups(both P>0. 05). ③ The foremost four in-hospital complications in the non-survivors and survivors were cardiac arrhythmia, cardiogenic shock, Killp Ⅱ-Ⅲ heart function and pulmonary infection in 60- 79 years group, but they were cardiac arrhythmia, pulmonary infection, Killp Ⅱ -Ⅲ heart function and cardiogenic shock in ≥80 years group. When compared the cases of in-hospital death between these two different age groups, the incidence of cardiogenic shock was significantly lower in the ≥ 80 years group (28. 1% vs.44.0%, P<0.01). However, the incidence of sudden death was higher in the ≥80 years group than that in 60 - 79 years group (22. 92% vs. 7.34%, P<0. 01). Conclusion The number and degree of in-hospital complications in elderly patients with AMI are increased by age. Cardiac arrhythmia is the major complication in elderly patients.For the patients 60-79 years old，it is more important to prevent and treat cardiogenic shock in order tO improve the outcome in the 60-70 years group.In very old people with AMI，it is important to prevent sudden death.