中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2013年
19期
1463-1468
,共6页
目的 收集具备冠心病危险因素的非心脏科住院患者的临床资料,分析其中发生急性心肌梗死患者的发病影响因素及其预后特点.方法 回顾性分析650例在天津市人民医院自2009年1月至2012年1月期间住院并具备冠心病危险因素的非心脏科住院患者.其中发生急性心肌梗死组99例.采用单因素分析的方法筛选出急性心肌梗死发病有意义的影响因素；采用多因素Logistic回归分析的方法分析出与AMI发病相关的危险因素；根据住院期间是否发生急性心肌梗死,分为非心肌梗死组(UnAMI组)551例；心肌梗死组(AMI组)99例,分析比较两组的住院期间心血管死亡事件发生率；采用Cox回归分析出两组的住院期间心血管死亡事件的独立危险因素.结果 (1)采用单因素分析的方法筛选出急性心肌梗死发病有意义的影响因素包括:TC、低密度脂蛋白(LDL)、高龄、中止抗血小板药物、Ⅱ级以上心绞痛、5年内是否血运重建、血糖是否控制、NYHAⅢ～Ⅳ级心功能不全、重度脱水、轻重度炎症反应、感染、外科围手术期、急诊手术及发病前是否心内科会诊.(2)多因素Logistic回归分析提示:LDL(OR:2.047,95％ CI:1.066 ～3.930,P=0.031)、中止抗血小板药物治疗(OR:15.213,95％ CI:5.746 ～ 40.281,P=0.000)、Ⅱ级以上心绞痛(OR:1.990,95％ CI:1.155 ～3.430,P=0.013)、血糖未控制(OR:2.991,95％ CI:1.485～6.026,P=0.002)、高龄(OR:2.499,95％ CI:1.299～4.808,P=0.006)、重症炎症反应(OR:4.425,95％ CI:2.984～6.561,P=0.000)、感染(OR:2.405,95％ CI:1.058 ～5.464,P=0.036)、急诊手术(OR:4.365,95％ CI:1.580～12.060,P=0.004)为AMI发生的相关因素；请心内科会诊(OR:0.011,95％ CI:0.003～0.040,P=0.000)为减少AMI发生的有利因素.(3)AMI组住院期间心血管死亡事件发生率明显高于UnAMI组.(4)高龄(β=0.776,OR=0.460,95％ CI:0.217～0.974,P=0.042)和未请心内科会诊(β=1.366,OR =3.918,95％ CI:1.549 ～9.912,P=0.004)为两组患者心血管死亡事件的独立危险因素.结论 (1)非心脏科住院患者住院期间LDL、中止抗血小板药物治疗、Ⅱ级以上心绞痛、血糖未控制、高龄、炎症反应、感染、急诊手术及未请心内科会诊为AMI发生的危险因素.(2)心内科专科指导治疗利于患者改善具备冠心病危险因素的非心脏科住院患者的预后.
目的 收集具備冠心病危險因素的非心髒科住院患者的臨床資料,分析其中髮生急性心肌梗死患者的髮病影響因素及其預後特點.方法 迴顧性分析650例在天津市人民醫院自2009年1月至2012年1月期間住院併具備冠心病危險因素的非心髒科住院患者.其中髮生急性心肌梗死組99例.採用單因素分析的方法篩選齣急性心肌梗死髮病有意義的影響因素；採用多因素Logistic迴歸分析的方法分析齣與AMI髮病相關的危險因素；根據住院期間是否髮生急性心肌梗死,分為非心肌梗死組(UnAMI組)551例；心肌梗死組(AMI組)99例,分析比較兩組的住院期間心血管死亡事件髮生率；採用Cox迴歸分析齣兩組的住院期間心血管死亡事件的獨立危險因素.結果 (1)採用單因素分析的方法篩選齣急性心肌梗死髮病有意義的影響因素包括:TC、低密度脂蛋白(LDL)、高齡、中止抗血小闆藥物、Ⅱ級以上心絞痛、5年內是否血運重建、血糖是否控製、NYHAⅢ～Ⅳ級心功能不全、重度脫水、輕重度炎癥反應、感染、外科圍手術期、急診手術及髮病前是否心內科會診.(2)多因素Logistic迴歸分析提示:LDL(OR:2.047,95％ CI:1.066 ～3.930,P=0.031)、中止抗血小闆藥物治療(OR:15.213,95％ CI:5.746 ～ 40.281,P=0.000)、Ⅱ級以上心絞痛(OR:1.990,95％ CI:1.155 ～3.430,P=0.013)、血糖未控製(OR:2.991,95％ CI:1.485～6.026,P=0.002)、高齡(OR:2.499,95％ CI:1.299～4.808,P=0.006)、重癥炎癥反應(OR:4.425,95％ CI:2.984～6.561,P=0.000)、感染(OR:2.405,95％ CI:1.058 ～5.464,P=0.036)、急診手術(OR:4.365,95％ CI:1.580～12.060,P=0.004)為AMI髮生的相關因素；請心內科會診(OR:0.011,95％ CI:0.003～0.040,P=0.000)為減少AMI髮生的有利因素.(3)AMI組住院期間心血管死亡事件髮生率明顯高于UnAMI組.(4)高齡(β=0.776,OR=0.460,95％ CI:0.217～0.974,P=0.042)和未請心內科會診(β=1.366,OR =3.918,95％ CI:1.549 ～9.912,P=0.004)為兩組患者心血管死亡事件的獨立危險因素.結論 (1)非心髒科住院患者住院期間LDL、中止抗血小闆藥物治療、Ⅱ級以上心絞痛、血糖未控製、高齡、炎癥反應、感染、急診手術及未請心內科會診為AMI髮生的危險因素.(2)心內科專科指導治療利于患者改善具備冠心病危險因素的非心髒科住院患者的預後.
목적 수집구비관심병위험인소적비심장과주원환자적림상자료,분석기중발생급성심기경사환자적발병영향인소급기예후특점.방법 회고성분석650례재천진시인민의원자2009년1월지2012년1월기간주원병구비관심병위험인소적비심장과주원환자.기중발생급성심기경사조99례.채용단인소분석적방법사선출급성심기경사발병유의의적영향인소；채용다인소Logistic회귀분석적방법분석출여AMI발병상관적위험인소；근거주원기간시부발생급성심기경사,분위비심기경사조(UnAMI조)551례；심기경사조(AMI조)99례,분석비교량조적주원기간심혈관사망사건발생솔；채용Cox회귀분석출량조적주원기간심혈관사망사건적독립위험인소.결과 (1)채용단인소분석적방법사선출급성심기경사발병유의의적영향인소포괄:TC、저밀도지단백(LDL)、고령、중지항혈소판약물、Ⅱ급이상심교통、5년내시부혈운중건、혈당시부공제、NYHAⅢ～Ⅳ급심공능불전、중도탈수、경중도염증반응、감염、외과위수술기、급진수술급발병전시부심내과회진.(2)다인소Logistic회귀분석제시:LDL(OR:2.047,95％ CI:1.066 ～3.930,P=0.031)、중지항혈소판약물치료(OR:15.213,95％ CI:5.746 ～ 40.281,P=0.000)、Ⅱ급이상심교통(OR:1.990,95％ CI:1.155 ～3.430,P=0.013)、혈당미공제(OR:2.991,95％ CI:1.485～6.026,P=0.002)、고령(OR:2.499,95％ CI:1.299～4.808,P=0.006)、중증염증반응(OR:4.425,95％ CI:2.984～6.561,P=0.000)、감염(OR:2.405,95％ CI:1.058 ～5.464,P=0.036)、급진수술(OR:4.365,95％ CI:1.580～12.060,P=0.004)위AMI발생적상관인소；청심내과회진(OR:0.011,95％ CI:0.003～0.040,P=0.000)위감소AMI발생적유리인소.(3)AMI조주원기간심혈관사망사건발생솔명현고우UnAMI조.(4)고령(β=0.776,OR=0.460,95％ CI:0.217～0.974,P=0.042)화미청심내과회진(β=1.366,OR =3.918,95％ CI:1.549 ～9.912,P=0.004)위량조환자심혈관사망사건적독립위험인소.결론 (1)비심장과주원환자주원기간LDL、중지항혈소판약물치료、Ⅱ급이상심교통、혈당미공제、고령、염증반응、감염、급진수술급미청심내과회진위AMI발생적위험인소.(2)심내과전과지도치료리우환자개선구비관심병위험인소적비심장과주원환자적예후.
Objeetive To collect the clinical data of non-cardiac inpatients with coronary heart disease risk factors and analyze the pathogenic factors and prognosis features of these inpatients with acute myocardial infarction.Methods Retrospective analyses were performed for 650 cases of consecutive noncardiac inpatients with coronary heart disease risk factors at Tianjin Union Medical Center between January 2009 and January 2012.They were divided into non myocardial infarction (UnAMI,n =551) and myocardial infarction groups (AMI,n =99).Firstly the method of single factor analysis was employed to screen some significant influencing factors of acute myocardial infarction.Secondly multivariate Logistic regression analysis was performed to analyze the risk factors associated with the onset of AMI.Also the cardiovascular death event rates during hospitalization were compared between two groups.Cox regression analysis was performedto analyze independent risk factors for cardiovascular death of two group during hospitalization.Results (1)The significant influencing factors of AMI included total cholesterol (TC),low-density lipoprotein (LDL),advanced age,discontinuation of antiplatelet drug,recent episodes of angina above Ⅱ grade,arrhythmia,5 years of PCI or CABG history,blood glucose control or not,cardiac dysfunction (NYHA Ⅱ-Ⅳ),dehydration,severe inflammatory response,infection,peroperative period,emergency operation and without cardiological consultation.(2)Multivariate Logistic regression analysis showed that LDL (OR(odds ratio):2.047,95％ CI (confidence interval):1.066-3.930,P =0.031),discontinuation of antiplatelet drug therapy (OR:15.213,95％ CI:5.746-40.281,P =0.000),recent episodes of angina above Ⅱ grade (OR:1.990,95％ CI:1.155-3.430,P =0.013),glucose non-control (OR:2.991,95％ CI:1.485-6.026,P =0.002),advanced age (OR:2.499,95 ％ CI:1.299-4.808,P =0.006),severe inflammation (OR:4.425,95 ％ CI:2.984-6.561,P =0.000),infection (OR:2.405,95 ％ CI:1.058-5.464,P =0.036),emergency operation (OR:4.365,95％ CI:1.580-12.060,P =0.004) were all AMI-related occurring factors.And cardiologic consultation (OR:0.011,95％ CI:0.003-0.040,P =0.000) was a favorable factors to reduce AMI; (3) AMI group during hospitalization for cardiovascular death event rate was higher than the UnAMI group; (4) Advanced age (β =0.776,OR =0.460,95％ CI:0.217-0.974,P =0.042) and without consultation of cardiology department (β =1.366,OR =3.918,95％ CI:1.549-9.912,P =0.004) were cardiovascular death independent risk factors.Conclusion (1) Non cardiac inpatients during hospitalization LDL,discontinuation antiplatelet drug therapy,recent episodes of angina above Ⅱ grade,blood sugar non-control,advanced age,severe inflammatory response,infection and without cardiologic consultations were significant risk factors for AMI.(2)The treatment of Department of Cardiology specialist for non cardiac inpatients with coronary heart disease risk factors to improve the prognosis of them.
