急性心肌梗死后合并多器官功能衰竭的老年患者预后相关因素分析

目的：探讨影响急性心肌梗死（AMI）后合并多器官功能衰竭（MODS）的老年患者预后相关因素。方法：回顾性分析84例AMI合并MODS患者病死率，根据患者预后分为存活组及死亡组，同时对预后相关情况、合并器官衰竭、治疗策略等30个因素进行组间比较，并将组间差别有统计学意义的因素进行多因素logistic回归分析。结果：患者病死率为56．0％。是否合并大面积前壁心肌梗死、是否合并陈旧性心肌梗死、是否合并肺部感染、是否出现心源性休克、是否使用IABP、Killip分级、是否使用机械通气及需要监护的时间等8个因素死亡组与存活组组间差异有统计学意义（均P〈0．05）。进一步多因素回归分析提示心源性休克、大面积前壁心肌梗死、肺部感染为AMI合并MODS的3个主要危险因素，OR分别为14．39、12．11及9．20。其中大面积前壁心肌梗死与心源性休克呈显著正相关（r=0．841，P〈0．01）。结论：急性心肌梗死合并多器官功能衰竭病死率高，尤其是出现大面积前壁心肌梗死、心源性休克等严重影响血流动力学及出现肺部感染等情况时，患者预后不良。如何防治血流动力学的急剧改变及肺部感染是改善老年AMI合并MODS患者预后的关键。

Investigation on Risk Factors in Elder Patients with Multiple Organs Dysfunction Followed Acute Myocardial Infarction

Objective：To explore the prognosis related factors in elder patients with multiple organs dysfunction （MODS） followed acute myocardial infarction （AMI）. Methods：The mortality of 84 patients with MODS followed AMI were respectively analyzed. And the patients were grouped into survival group and death group based on the prognosis. And the difference of 30 factors, included general characteristics, failure organs and therapeutic strategies between survival group and death group were compared. And factors that had significantly difference between groups were analyzed with multiple logistic regression analysis. Results：The mortality of elder patients with AMI complicated with MODS is 56.0 %. And there were 8 factors that had significantly difference between tow groups,included large scale anterior wall cardiac infarction, old cardiac infarction, lung infection, cardiac shock, IABP, Killip stage, mechanical ventilation adoption and days needed intensive care. And the cardiac shock ,large-scale anterior wall cardiac infarction and lung infection were 3 main risk factors（ OR = 14.39,12.11 and 9.2 respectively, all P 〈 0.01 ）. But large-scale anterior wall cardiac infarction has a significantly positive relationship with cardiac shock （ r = 0. 84, P 〈 0. 01 ）. Conclusion： The mortality of elder AMI patients complicated with MODS is high. Patient who with the characteristic of severe hemodynamic change effected by large-scale anterior wall cardiac infarction, cardiac shock and lung infection is vulnerable to have a bad outcome. Reducing the dramatic hemodynamics change and reducing the lung infection are the key point to improve the outcome of elder AMI patients complicated with MODS.