中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2014年
8期
836-839
,共4页
张光宇%汪小丁%余志敏%王智泉
張光宇%汪小丁%餘誌敏%王智泉
장광우%왕소정%여지민%왕지천
急性心肌梗死%住院治疗%死亡%危险因素
急性心肌梗死%住院治療%死亡%危險因素
급성심기경사%주원치료%사망%위험인소
Acute myocardial infarction%Hospital treatment%Death%Risk factors
目的 探讨急性心肌梗死(AMI)患者住院期间的死亡相关危险因素,从而指导临床治疗,减少患者住院期间死亡的发生.方法 回顾性分析2010年1月至2013年6月入住我院心内科,发病在24 h内的270例AMI患者的临床资料,根据住院期间治疗终点分为死亡组(32例)和好转组(232例),通过比较两组间基础和临床资料及单因素和多因素logistic回归分析等方法评价各危险因素及临床指标对AMI患者死亡的影响.结果 基线临床资料比较发现两组间患者年龄[(65.21±13.55)岁与(76.41±10.19)]、血肌酐水平(SCr)[(100.23±65.99) μmol/L与(139.22±92.03)μmol/L]差异有统计学意义(P均＜0.001),其余基线资料比较差异均无统计学意义;住院临床资料比较发现两组间住院期间心律失常发生率(14.7％与31.3％)、前降支病变率(50.4％与81.3％)、回旋支病变率(48.7％与68.8％)、超敏C反应蛋白(hs-CRP)水平[(5.92±4.41) mg/L与(10.82±2.29) mg/L]、脑钠肽(BNP)水平[(844.89±1 108.41) ng/L与(1 210.57±984.44) ng/L]及肌酸激酶同工酶(CK-MB)[(87.99±140.45) U/L与(161.86 ±214.75) U/L]差异均有统计学意义(P均＜0.05);多因素logistic回归分析显示高龄(OR=1.078,95％ CI:1.014～1.118,P=0.015)、住院期间发生的心律失常(OR=1.636,95％CI:1.151 ～3.041,P=0.024)、前降支病变(OR=1.428,95％CI:1.143 ～2.437,P=0.018)、hs-CRP(OR=1.352,95％ CI:1.137～1.607,P=0.001)是AMI患者死亡的独立危险因素.结论 高龄、住院期间发生的心律失常、冠状动脉左前降支病变及高水平hs-CRP是AMI患者死亡的独立危险因素,在治疗过程应采取相关措施,降低其死亡风险.
目的 探討急性心肌梗死(AMI)患者住院期間的死亡相關危險因素,從而指導臨床治療,減少患者住院期間死亡的髮生.方法 迴顧性分析2010年1月至2013年6月入住我院心內科,髮病在24 h內的270例AMI患者的臨床資料,根據住院期間治療終點分為死亡組(32例)和好轉組(232例),通過比較兩組間基礎和臨床資料及單因素和多因素logistic迴歸分析等方法評價各危險因素及臨床指標對AMI患者死亡的影響.結果 基線臨床資料比較髮現兩組間患者年齡[(65.21±13.55)歲與(76.41±10.19)]、血肌酐水平(SCr)[(100.23±65.99) μmol/L與(139.22±92.03)μmol/L]差異有統計學意義(P均＜0.001),其餘基線資料比較差異均無統計學意義;住院臨床資料比較髮現兩組間住院期間心律失常髮生率(14.7％與31.3％)、前降支病變率(50.4％與81.3％)、迴鏇支病變率(48.7％與68.8％)、超敏C反應蛋白(hs-CRP)水平[(5.92±4.41) mg/L與(10.82±2.29) mg/L]、腦鈉肽(BNP)水平[(844.89±1 108.41) ng/L與(1 210.57±984.44) ng/L]及肌痠激酶同工酶(CK-MB)[(87.99±140.45) U/L與(161.86 ±214.75) U/L]差異均有統計學意義(P均＜0.05);多因素logistic迴歸分析顯示高齡(OR=1.078,95％ CI:1.014～1.118,P=0.015)、住院期間髮生的心律失常(OR=1.636,95％CI:1.151 ～3.041,P=0.024)、前降支病變(OR=1.428,95％CI:1.143 ～2.437,P=0.018)、hs-CRP(OR=1.352,95％ CI:1.137～1.607,P=0.001)是AMI患者死亡的獨立危險因素.結論 高齡、住院期間髮生的心律失常、冠狀動脈左前降支病變及高水平hs-CRP是AMI患者死亡的獨立危險因素,在治療過程應採取相關措施,降低其死亡風險.
목적 탐토급성심기경사(AMI)환자주원기간적사망상관위험인소,종이지도림상치료,감소환자주원기간사망적발생.방법 회고성분석2010년1월지2013년6월입주아원심내과,발병재24 h내적270례AMI환자적림상자료,근거주원기간치료종점분위사망조(32례)화호전조(232례),통과비교량조간기출화림상자료급단인소화다인소logistic회귀분석등방법평개각위험인소급림상지표대AMI환자사망적영향.결과 기선림상자료비교발현량조간환자년령[(65.21±13.55)세여(76.41±10.19)]、혈기항수평(SCr)[(100.23±65.99) μmol/L여(139.22±92.03)μmol/L]차이유통계학의의(P균＜0.001),기여기선자료비교차이균무통계학의의;주원림상자료비교발현량조간주원기간심률실상발생솔(14.7％여31.3％)、전강지병변솔(50.4％여81.3％)、회선지병변솔(48.7％여68.8％)、초민C반응단백(hs-CRP)수평[(5.92±4.41) mg/L여(10.82±2.29) mg/L]、뇌납태(BNP)수평[(844.89±1 108.41) ng/L여(1 210.57±984.44) ng/L]급기산격매동공매(CK-MB)[(87.99±140.45) U/L여(161.86 ±214.75) U/L]차이균유통계학의의(P균＜0.05);다인소logistic회귀분석현시고령(OR=1.078,95％ CI:1.014～1.118,P=0.015)、주원기간발생적심률실상(OR=1.636,95％CI:1.151 ～3.041,P=0.024)、전강지병변(OR=1.428,95％CI:1.143 ～2.437,P=0.018)、hs-CRP(OR=1.352,95％ CI:1.137～1.607,P=0.001)시AMI환자사망적독립위험인소.결론 고령、주원기간발생적심률실상、관상동맥좌전강지병변급고수평hs-CRP시AMI환자사망적독립위험인소,재치료과정응채취상관조시,강저기사망풍험.
Objective To explore the risk factors related to death in patients with acute myocardial infarction(AMI) in hospital,so as to guide clinical treatment to reduce the occurrence of death.Methods Two hundred and seventy cases with AMI who got in infarction within 24 h were studied in the Cardiology Departmentof Zhongnan Hospital of Wuhan University from Jan.2010 and Jun.2013.The patients were divided into the death group(n =32) and the cured group(n =232) according to the endpoint in hospital.The clinical information was recorded and multiple factors logistic regression analysis was applied to analyze the risk factors of death due to AMI.Results The age,serum creatinine(Cr) in both groups were ((65.21 ± 13.55) years old,(76.41 ±10.19) years old) and ((100.23 ±65.99) μmol/L,(139.22 ±92.03) μmol/L) and there were statistically significant differences (P ＜ 0.05).The differences of other indicators in two groups were no statistically significant.Clinical data comparison between the two groups showed that incidence rate of arrhythmia (14.7％),the disease rate of anterior descending coronary artery (50.4％),the disease rate of circumflex branch coronary artery (48.7％),the level of high sensitivity C reactionprotein (hs-CRP) ((5.92 ± 4.41) mg/L),brain natriuretic peptide (BNP) ((844.89 ± 1108.41) ng/L) and creatine kinase-MB (CK-MB) ((87.99 ± 140.45)U/L) in death group were lower than those in cured group (31.3％,81.3％,68.8％,(10.82 ± 2.29) mg/L,(1210.57 ± 984.44) ng/L,(161.86 ± 214.75) U/L; P ＜ 0.05).Multiple factors logistic regression analysis showed that elder age (OR =1.078,95 ％ CI:1.014-1.118,P =0.015),arrhythmia occurred or not in hospital (OR =1.636,95％ CI:1.151-3.041,P =0.024),the pathological changes of anterior descending coronary artery (OR =1.428,95 ％ CI:1.143-2.437,P =0.018),the level of hs-CRP (OR =1.352,95％ CI:1.137-1.607,P =0.001) were the independent risk factors for myocardial infarction patients' death.Conclusion Elder age,arrhythmia occurred in hospital,the pathological changes of anterior descending coronary artery,the high level of hs-CRP are the independent risk factors for AMI patients death.Relevant measures in the treatment should be taken to reduce their risk of death.
