摘要
目的分析580例急性心肌梗死(AMI)患者院前延误时间分布及心肌梗死后不同时间段的死亡情况。方法回顾性分析2004年3月至2006年3月北京安贞医院抢救中心急诊室和急诊重症监护室收治的 AMI 患者580例,其中男性428例,女性152例,平均年龄(60.7±12.9)岁。将记录的就诊时间与发病时间的时间差作为院前延误时间(PDT)。根据 PDT 不同分为7个时间段:即1～30 min,31～60 min,61～120 min,121～240 min,241～360 min,361～720 min,>720 min。统计PDT 分布,计算各时间段心室颤动(室颤)发生率、复苏成功率、病死率,并对不同时间段死亡原因相关因素进行分析。结果 580例 AMI 患者 PDT 中位数时间为130 min。接受溶栓治疗122例(21.0%),急诊 PCI 及冠状动脉搭桥术(CABG)266例(45.9%),其他药物对症治疗192例(33.1%);比较三组 PDT,溶栓组[(104.5±2.3)min]和PCI/CABG组[(119.1±2.3)min]均低于其他药物治疗组[(290.9±3.4)min,P<0.05]。发生室颤46例(7.9%),其中 PDT≤30 min 24.4%(11/45),31～60 min 7.7%(8/104),61～120 min 10.3%(14/136),121～240 min 6.6%(8/121),241～360 min 1.9%(1/54),361～720 min 3.3%(2/61),>720 min 3.4%(2/59);复苏成功率71.7%(33/46),总病死率5.3%。年龄(OR=1.047,P=0.004)、糖尿病(OR=2.159,P=0.02)和 PDT(OR=2.159,JP=0.023)是影响患者预后的独立相关因素。结论缩短 PDT,及早进入治疗程序,挽救濒死心肌,对预防室颤、猝死发生,降低病死率至关重要。
Objective To determine the relationship between prehospital delay time （PDT） and other associated factors on mortality in patients with acute myocardial infarction. Methods We retrospectively analyzed factors associated with mortality in 580 patients with acute myocardial infarction presented to the Emergency Ward and Emergency Intensive Care Unit （EICU） of Beijing Anzhen Hospital from March 2004 to March 2006 （428 males, average age： 60. 7 ± 12. 9 years）. The patients were divided to 3 groups according various therapies： thrembolysis, PCI/CABG or symptomatic medication groups. Results The median PDT was 130 min. Thrembolysis, PCI/CABG and medical therapy were applied in 122 （21.0%）, 266 （45.9%） and 192 （33. 1% ） patients respectively. PDT was significantly longer in patients receiving medical therapy （290.9 min ± 3.4 min） compared to patients treated with thrembolysis （104.5 min ±2.3 min） and PCI/CABG （119.1 min ±2.3 min, all P〈0.05）. The overall mortality rate was 5. 3% （31/580） and all occurred in patients with medical therapy group mostly due to irreversible ventricular fibrillations. Old age （OR = 1. 047, P =0. 004）, diabetes mellitus （OR =2. 159, P = 0. 02 ） and PDT （ OR = 2. 159, P = 0. 023 ） are independent predict factors for mortality. Conclusion Coronary Revascularisation by thrembolysis, PCI or CABG early post acute myocardial infarction is the key issue for reducing mortality in patients with acute myocardial infarction.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2007年第1期40-43,共4页
Chinese Journal of Cardiology
关键词
心肌梗塞
死亡原因
心室颤动
猝死
心脏
Myocardial infarction
Cause of death
Ventricular fibrillation
Death, sudden, cardiac
