CAJ | 학술논문

目的评价老年非ST段抬高心肌梗死(NSTEMI)患者住院死亡的相关因素. 方法选择年龄≥65岁的老年NSTEMI住院患者302例,其中死亡32例(死亡组),存活组270例.回顾性分析其临床资料,评价院内死亡相关因素. 结果两组性别、既住高血压、糖尿病、高脂血症,吸烟、心绞痛、心肌梗死、脑血管病、已知肾功能不全史比较,差异无统计学意义(均为P＞0.05).死亡组并存≥3种慢性疾病、入院心率＞100次/min、入院心功能高Killip分级(Ⅲ、Ⅳ级)、入院血白细胞＞10×109L高于存活组,差异均有统计学意义(P＜0.05);两组人院24 h内空腹血糖水平及入院血清肌酐水平比较,差异无统计学意义(P＞0.05),但结合估算肾小球滤过率(eGFR)重新评估肾功能状态后,死亡组肾功能不全高于存活组(P＜0.01);死亡组并存肺部感染者高于存活组(P＜0.01).多因素Logistic分析结果显示,入院时心功能高Killip分级、eGFR评估的肾功能不全、并存肺部感染是老年NSTEMI患者住院期间死亡的独立预测因素. 结论并存多种慢性病是老年NSTEMI患者死亡的原因之一;eGFR评估肾功能不全、并存肺部感染是老年NSTEMI患者死亡的独立预测因素.
목적 평개노년비ST단태고심기경사(NSTEMI)환자주원사망적상관인소. 방법 선택년령≥65세적노년NSTEMI주원환자302례,기중사망32례(사망조),존활조270례.회고성분석기림상자료,평개원내사망상관인소. 결과 량조성별、기주고혈압、당뇨병、고지혈증,흡연、심교통、심기경사、뇌혈관병、이지신공능불전사비교,차이무통계학의의(균위P＞0.05).사망조병존≥3충만성질병、입원심솔＞100차/min、입원심공능고Killip분급(Ⅲ、Ⅳ급)、입원혈백세포＞10×109L고우존활조,차이균유통계학의의(P＜0.05);량조인원24 h내공복혈당수평급입원혈청기항수평비교,차이무통계학의의(P＞0.05),단결합고산신소구려과솔(eGFR)중신평고신공능상태후,사망조신공능불전고우존활조(P＜0.01);사망조병존폐부감염자고우존활조(P＜0.01).다인소Logistic분석결과 현시,입원시심공능고Killip분급、eGFR평고적신공능불전、병존폐부감염시노년NSTEMI환자주원기간사망적독립예측인소. 결론 병존다충만성병시노년NSTEMI환자사망적원인지일;eGFR평고신공능불전、병존폐부감염시노년NSTEMI환자사망적독립예측인소.
Objective To analyze hospitalized death related factors in elderly patients with nonST-segment elevation myocardial infarction (NSTEMI). Methods Three hundred and two patients (≥65 years old) with NSTEMI were included. Thirty-two patients of them died in hospital (death group). Their clinical data were retrospectively analyzed and correlated factors for in-hospital death were evaluated. Results Compared with survival group, patients in death group were more likely to have 3 or more chronic diseases,heart function killip grades Ⅲ- Ⅳ, heart rate＞ 100/min and peripheral blood WBC count＞10X 10＜'9＞/L on admission (all P＜:0.05). There was no significant difference in fasting plasma glucose level and serum creatinine on admission between the two groups (both P:＞0.05). But after glomerular filtration rate(eGFR) were estimated by the modified abbreviated MDRD equations based on the Chinese CKD patients, patients in death group were more likely to be with renal dysfunction and pulmonary infection (both P＜0.01 ). Multiple logistic regression analysis showed that heart function killip grades Ⅲ-Ⅳ, renal dysfunction evaluated by eGFR, pulmonary infection on admission were the independent predictors for in-hospital death in elderly patients with NSTEMI. Conclusions Coexistence of 3 or more chronic diseases is a related factor of death and heart function killip grades Ⅲ-Ⅳ, renal dysfunction evaluated by eGFR and pulmonary infection are the independent predictors for in-hospital death in elderly patients with NSTEMI.