CAJ | 학술논문

目的探讨急性心肌梗死后严重感染的发病率、临床特点及预后.方法对2010年5月至2012年9月在高州市人民医院心内科住院的220例ST段抬高型心肌梗死患者的数据进行分析.收集所有患者有关感染的详细数据,对患者的感染和感染细节特点进行描述.在调整相关的临床变量并设感染率为时间相关的协变量,使用Cox比例风险模型评估罹患感染及未患感染患者90 d内的临床结果.结果 53例(24％)患者发生了感染,其中大部分为单一部位感染.确诊感染的中位时间(第25、75百分位数)为3(1,6)d.最常见的病原体为金黄色葡萄球菌,主要感染部位为血液.与未患感染的患者相比这些患者通常合并症较多,经皮冠状动脉介入治疗手术成功率比较低,严重感染与90 d内病死率[HR:5.6;95％可信区间(CI):3.8～8.4]和死亡、心肌梗死率(HR:4.9;95％CI:3.4～7.1)显著升高相关.结论 ST段抬高型心肌梗死患者并发感染的情况不常见,但与较差的90d内预后结果显著相关.需要早期明确高危患者并提供降低其感染风险的策略.
목적 탐토급성심기경사후엄중감염적발병솔、림상특점급예후.방법 대2010년5월지2012년9월재고주시인민의원심내과주원적220례ST단태고형심기경사환자적수거진행분석.수집소유환자유관감염적상세수거,대환자적감염화감염세절특점진행묘술.재조정상관적림상변량병설감염솔위시간상관적협변량,사용Cox비례풍험모형평고리환감염급미환감염환자90 d내적림상결과.결과 53례(24％)환자발생료감염,기중대부분위단일부위감염.학진감염적중위시간(제25、75백분위수)위3(1,6)d.최상견적병원체위금황색포도구균,주요감염부위위혈액.여미환감염적환자상비저사환자통상합병증교다,경피관상동맥개입치료수술성공솔비교저,엄중감염여90 d내병사솔[HR:5.6;95％가신구간(CI):3.8～8.4]화사망、심기경사솔(HR:4.9;95％CI:3.4～7.1)현저승고상관.결론 ST단태고형심기경사환자병발감염적정황불상견,단여교차적90d내예후결과현저상관.수요조기명학고위환자병제공강저기감염풍험적책략.
Objective To investigate the morbidity,chinical features and prognosis of serious infections after acute myocardial infarction(AMI).Methods The clinical data of 220 patients with ST segment elevation myocardial infarction admitted in our department,from May 2010 to September 2012,were analyzed.Detailed informations about infection were collected for all patients.The characteristics of infection and details of infection was described.Cox proportional hazards models were used to assess 90-day outcomes among patients with and without infections after adjusting for associated clinical variables and with infection as a time-dependent covariate.Results Overall,53 patients(24％) developed a serious infection,most of whom presented with a single-site infection.The median (25th,75th percentile) time until diagnosis of infection was 3 (1,6) days.The most commonly identified organism was Staphylococcus aureus,and the main location of infection was the blood.These patients had more complications and lower procedural success at index percutaneous coronary intervention than those without infections.Serious infection was correlated with significantly higher rates of 90-day death(adjusted hazard ratio:5.6 ; 95％ confidence interval:3.8 to 8.4),death' rate of MI (adjusted hazard ratio:4.9 ; 95％ confidence interval:3.4 to 7.1).Conclusions Infections complicating the course of patients with STEMI are uncommon but markedly correlated with worse 90-day clinical outcomes.Mechanisms for early identification of these high-risk patients as well as design of strategies to reduce their risk of infection are warranted.