CAJ | 학술논문

目的分析急性心肌梗死(AMI)患者的住院死亡原因及相关危险因素.方法选择2003年1月至2008年6月住院的AMI患者1252例,对其中118例院内死亡患者临床资料进行回顾性研究,记录死亡原因,分析死亡高危因素.结果 AMI患者总病死率9.42%(118/1252).男性AMI病死率8.91%(84/943),女性AMI病死率11.00%(34/309),女性患者AMI病死率高于男性,但差异无统计学意义(X2=1.1972,P=0.2739).随着年龄增长,AMI病死率增高,＜40岁、40～54岁.55～64岁、≥65岁组的病死率分别为6.45%(2/31)、2.56%(6/234)、5.11%(16/313)、13.95%(94/674),差异有统计学意义(X2=36.1871,P＜0.0001).在118例AMI死亡病例中,泵衰竭77例(65.25%),心脏骤停21例(17.80%),心脏破裂13例(11.02%),心外原因(包括脑出血、消化道出血、肺炎等)7例(5.93%),死亡原因中泵衰竭比例最高.AMI介入患者与AMI非介入患者病死率分别为4.24%(39/920)、23.80%(79/332),心脏破裂发生率分别为0.33%(3/920)、3.01%(10/332)(X2分别为109.2943、20.0717,P均＜0.0001).在AMI患者中心脏破裂的发生率为1.04%(13/1252),女性患者的心脏破裂发生率为2.91%(9/309),男性为0.42%(4/943)(X2=14.0254,P＜0.0001).AMI死亡距发病时间＜24 h者占23.72%(28/118),24 h～1周占55.93%(66/118),1～4周占20.34%(24/118).广泛前壁、前间壁、下壁、侧壁、后壁、非ST段抬高性心肌梗死的病死率分别为12.47%(59/473)、9.23%(12/130)、6.73%(28/416)、8.70%(4/46)、5.97%(4/67)、9.17%(11/120)(X2=9.6675,P=0.0852).结论高龄是AMI患者死亡的重要危险因素,死亡多发生于病程早期,泵衰竭是主要死亡原因,AMI介入患者病死率及心脏破裂发生率均较非介入患者明显降低,AMI中女性患者心脏破裂的发生率明显高于男性.性别、心肌梗死部位可能也是死亡的重要危险因素,需要更大样本量来验证.
목적 분석급성심기경사(AMI)환자적주원사망원인급상관위험인소.방법 선택2003년1월지2008년6월주원적AMI환자1252례,대기중118례원내사망환자림상자료진행회고성연구,기록사망원인,분석사망고위인소.결과 AMI환자총병사솔9.42%(118/1252).남성AMI병사솔8.91%(84/943),녀성AMI병사솔11.00%(34/309),녀성환자AMI병사솔고우남성,단차이무통계학의의(X2=1.1972,P=0.2739).수착년령증장,AMI병사솔증고,＜40세、40～54세.55～64세、≥65세조적병사솔분별위6.45%(2/31)、2.56%(6/234)、5.11%(16/313)、13.95%(94/674),차이유통계학의의(X2=36.1871,P＜0.0001).재118례AMI사망병례중,빙쇠갈77례(65.25%),심장취정21례(17.80%),심장파렬13례(11.02%),심외원인(포괄뇌출혈、소화도출혈、폐염등)7례(5.93%),사망원인중빙쇠갈비례최고.AMI개입환자여AMI비개입환자병사솔분별위4.24%(39/920)、23.80%(79/332),심장파렬발생솔분별위0.33%(3/920)、3.01%(10/332)(X2분별위109.2943、20.0717,P균＜0.0001).재AMI환자중심장파렬적발생솔위1.04%(13/1252),녀성환자적심장파렬발생솔위2.91%(9/309),남성위0.42%(4/943)(X2=14.0254,P＜0.0001).AMI사망거발병시간＜24 h자점23.72%(28/118),24 h～1주점55.93%(66/118),1～4주점20.34%(24/118).엄범전벽、전간벽、하벽、측벽、후벽、비ST단태고성심기경사적병사솔분별위12.47%(59/473)、9.23%(12/130)、6.73%(28/416)、8.70%(4/46)、5.97%(4/67)、9.17%(11/120)(X2=9.6675,P=0.0852).결론 고령시AMI환자사망적중요위험인소,사망다발생우병정조기,빙쇠갈시주요사망원인,AMI개입환자병사솔급심장파렬발생솔균교비개입환자명현강저,AMI중녀성환자심장파렬적발생솔명현고우남성.성별、심기경사부위가능야시사망적중요위험인소,수요경대양본량래험증.
Objective To analyze causes of death and risk factors of acute myocardial infarction(AMI)、Methotis 118 AMI patients who died f selected from 1252 hospitalized patients with AMI from January 2003 to June 2008)were retrospectively enrolled for analysis of risk factors and death causes.Resuits The overall mortality of hospitalized patients with AMI was 9.42%(118/1252).The mortality rate in the males was 8.91%(84/943)while in the females was 11.00%(34/309)which was higher than the males but there was no statistical difieFence (P=0.2739).Mortality rate rose along with age and showed significant statistical difference(P＜0.0001)among different age group[＜40 yrs:6.45%(2/31),40～54:2.56%(6/234),55～64:5.11%(16/313),≥65:13.95%(94/674)].Pump failure occurred in 77 cases(65.25%)which was the main cause of death,cardiac arrest occurred in 21 cases(17.80%)and heart rupture in 13 cases(11.02%).There existed other causes of death including cerebral hemorrhage.digestive tract bleeding and pneumonia in 7 cases(5.93%).The mortality of patients with PCI was 4.24%(39/920)while23.80%(79/332)of those witbout PCI(P＜0.0001).Rate of cardiac rupture was 1.04%(13/1252),2.91%(9/309)in females and 0.42%(4/943)in males(P＜0.0001).The time was＜24 h(23.72%.28/118)when death occurred from onset,24 h～1 week(55.93%,66/118)and 1～4 week (20.34%,24/118).There was no statistical difference of mortality related to different infarction locations[antior 12.47%(59/473),anteroseptal 9.23%(12/130),inferior 6.73%(28/416),lateral 8.70%(4/46),ventricle postwall 5.97%(4/67),and ST-segmental elevated myocardial infarction 9.17%(11/120)(P=0.0852)].Conclusions There is a high mortality in aged patients with AMl with heart failure as the most common cause of death which usually occurs at early stage of AMI.The females have more cardiac ruptures than the males.PCI significantly decreases rates of mortality and cardiac rupture.Moreover.gender and location of AMI might be another important risk factor which affect mortality.