摘要
目的 :探讨高龄老人 (≥ 80岁 )急性心肌梗死 (AMI)患者并发泵衰竭〔慢性心力衰竭和 (或 )心原性休克〕的影响因素。方法 :以 1993年 1月至 2 0 0 2年 8月相继收住中国人民解放军总医院冠心病监护病房 12 3例高龄AMI患者为对象 ,对比分析泵衰竭组 ( 4 1例 )与对照组 ( 82例 ,无泵衰竭 )患者的病史、临床表现、并发症等特点 ,以Logistic多因素逐步回归分析高龄AMI并发泵衰竭的影响因素。结果 :泵衰竭组陈旧性心肌梗死病史、前壁或多部位AMI、肺部湿音、血白细胞计数≥ 10× 10 9/L、左心室射血分数≤ 0 5、应用阿司匹林治疗、心律失常发生率、肺炎发生率、下壁、侧壁或非Q波AMI、住院期间病死率均与对照组有显著性差异 (P <0 0 5或P <0 0 1)。Logistic多因素逐步回归分析表明 ,陈旧性心肌梗死病史 ,前壁或多部位AMI ,合并肺炎是高龄AMI并发泵衰竭的独立影响因素 ,风险比值和 95 %可信限分别为 2 60 0、1 10 4～ 6 12 2和 3 898、1 63 9～ 9 2 70及 3 790、1 5 16～ 9 473 )。结论 :高龄AMI患者有陈旧性心肌梗死病史。
Objective:To investigate the impact factors of heart failure in very old patients(aged 80 years and older)with acute myocardial infarction(AMI). Methods:One hundred and twenty-three very old patients with AMI were admitted to the Chinese PLA General Hospital from January 1st,1993 to August 31th,2002.Patients were divided into two groups.The patients in group A was associated with heart failure and the patients in group B was not.Their clinical characteristics,risk factors,clinical presentations,treatment,complications and in-hospital mortality were analyzed. Results:Univariate analysis indicated that history of previous MI,anterior or multiple position AMI,rales to be heard in the chest,high white blood cell account(≥10×10 9/L),low left ventricular ejection fraction(<50%),in-hospital complications including arrhythmia and pneumonia,as well as the therapy without aspirin were significantly associated with the heart failure.The patients with heart failure had a higher in-hospital mortality rate than those in the control group.Multivariate logistic regression analysis using heat failure as a dependent variable and the history,in-hospital complications and so on as independent variables,the major determinants of the heart failure were the history of previous myocardial infarction(odds ratio 2.600,95% confidence interval(CI)1.104 to 6.122),anterior or multiple position AMI (odds ratio 3.898,95% CI 1.639 to 9.270)and in-hospital complication of pneumonia(odds ratio 3.790,95% CI 1.516 to 9.473). Conclusions:Those findings demonstrate that the history of previous myocardial infarction and anterior or multiple position AMI,as well as in-hospital complication of pneumonia were the independent impact factors of heart failure in very old patients with AMI.
出处
《中国循环杂志》
CSCD
北大核心
2004年第3期168-171,共4页
Chinese Circulation Journal
关键词
急性心肌梗死
泵衰竭
影响因素
并发症
Heart failure
Myocardial infarction
Aged
Logistic multivariate regression analysis
