CAJ | 학술논문

目的：探讨入院时影响老年急性心肌梗死（AMI）患者住院病死率的危险因素。方法选取因AMI收住的356例老年患者为研究对象。分析病死组（45例）与存活组（311例）患者的临床特征、实验室化验指标、心血管并发症（心源性休克、心力衰竭、室速/室颤），以Logistic多因素逐步回归分析影响老年AMI患者住院病死率的相关因素。结果单因素分析显示：年龄、糖尿病史、陈旧性MI病史、脑卒中病史、肾功能不全、贫血、首发症状呼吸困难、并发心源性休克、心力衰竭、室速/室颤，入院时血清肌酐升高、肾小球滤过率（eGFR）及血红蛋白减低、肌酸激酶及其同工酶峰值水平与老年AMI患者住院病死率相关（均P ＜0．05）。多因素分析显示：年龄、糖尿病史、陈旧性MI病史，并发心源性休克、心力衰竭、室速/室颤，入院时eGFR水平是影响老年AMI患者住院病死率的独立危险因素（均P ＜0．05）。结论年龄、糖尿病及陈旧性MI病史、发生心血管并发症、入院时eGFR水平是影响老年AMI患者住院病死率的独立危险因素。
목적：탐토입원시영향노년급성심기경사（AMI）환자주원병사솔적위험인소。방법선취인AMI수주적356례노년환자위연구대상。분석병사조（45례）여존활조（311례）환자적림상특정、실험실화험지표、심혈관병발증（심원성휴극、심력쇠갈、실속/실전），이Logistic다인소축보회귀분석영향노년AMI환자주원병사솔적상관인소。결과단인소분석현시：년령、당뇨병사、진구성MI병사、뇌졸중병사、신공능불전、빈혈、수발증상호흡곤난、병발심원성휴극、심력쇠갈、실속/실전，입원시혈청기항승고、신소구려과솔（eGFR）급혈홍단백감저、기산격매급기동공매봉치수평여노년AMI환자주원병사솔상관（균P ＜0．05）。다인소분석현시：년령、당뇨병사、진구성MI병사，병발심원성휴극、심력쇠갈、실속/실전，입원시eGFR수평시영향노년AMI환자주원병사솔적독립위험인소（균P ＜0．05）。결론년령、당뇨병급진구성MI병사、발생심혈관병발증、입원시eGFR수평시영향노년AMI환자주원병사솔적독립위험인소。
Objective To investigate the factors associated with in-hospital mortality among elderly patients with acute myocardial infarction (AMI).Methods 356 elderly patients with AMI were admitted from Jan,2001 to Jan,2013.The patients were divided into two groups:the death group(n=45)and the survival group(n=311).The clinical characteristics,laboratory tests and cardiovascular complications (cardiogenic shock,heart failure,ventricular tachycardia or fibrillation)were analyzed.The multiple factors analysis were carried out through Logistic regression. Results The age,the history of diabetes,myocardial infarction and stroke,impaired renal function,anemia,incipient dyspnea,cardiogenic shock,heart failure and ventricular tachycardia or fibrillation,the increased level of serum creat-inine,and the decreased levels of glomerular filtration rate(GFR)and haematoglobin on admission,and the levels of creatine kinase and its isoenzyme were significantly associated with the in-hospital mortality (P <0.05).Multivariate logistic regression analysis showed that the major risk factors of the in-hospital mortality were age,history of diabetes and myocardial infarction,cardiogenic shock,heart failure,ventricular tachycardia,fibrillation,and the level of GRF on admission (P <0.05).Conclusion Age,the history of diabetes and myocardial infarction,cardiovascular complica-tions,and the level of GFR on admission are the independent predictors of in-hospital mortality among elderly patients with AMI.