摘要
目的探讨老年COPD急性加重期(AECOPD)患者合并急性心肌梗死的临床特征,以减少误诊及漏诊。方法回顾性分析郑州人民医院呼吸科2007年5月至2009年12月收治的16例老年AECOPD合并急性心肌梗死患者的临床资料,与同时期未合并急性心肌梗死的128例老年AECOPD患者(对照组)的临床资料进行比较。结果两组患者均无典型心前区疼痛、意识障碍及低血压。与对照组相比,急性心肌梗死组患者主要症状为胸闷、呼吸困难加重(16/16比4/128,P<0.01),多伴有发热(11/16比6/128,P<0.005)、食欲减退(10/16比23/128,P<0.05);胸部X线检查斑片状阴影检出率增加(16/16比62/128,P<0.05);PaO2明显降低[(43.72±3.64)mm Hg比(82.26±11.41)mm Hg,P<0.01];血红细胞计数偏高[(6.43±0.42)×1012/L比(4.11±1.24)×1012/L,P<0.05)],总胆固醇含量偏高[(6.51±0.84)mmol/L比(3.93±1.14)mmol/L,P<0.05),有创机械通气需求增加(13/16比11/128,P<0.05);住院时间明显延长[(35±13)d比(11±3)d,P<0.001)],住院费用明显增加[(3.20±1.10)万元比(0.76±0.28)万元,P<0.01)],住院期间死亡率增加(2/16比3/128,P<0.01)。结论当老年AECOPD患者突然出现胸闷、呼吸困难加重,应警惕急性心肌梗死的发生。
Objective To investigate the clinical characteristics of acute myocardial infarction（AMI） in elderly patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）.Methods Clinical data of 16 elderly patients with AECOPD and AMI from may 2007 to December 2009 were reviewed.Meanwhile,128 elderly AECOPD patients without AMI were analyzed as control.Results Neither the AMI group nor the control group had typical precordial pain,conscious disturbance,and hypotension.Compared with the control group,the main symptoms of the AMI group were worsening of chest tightness and dyspnea（16/16 vs.4/128,P〈0.01）,most of which accompanying fever（11/16 vs.6/128,P〈0.05） and anorexia（10/16 vs.23/128,P0.05）.The incidence of patches-like shadow on chest X-ray increased（16/16 vs.62/128,P〈0.05）,PaO2（mm Hg） decreased（43.72±3.64 vs.82.26±11.41,P〈0.001）,the red blood cell count（×1012/L） increased（6.43±0.42 vs.4.11±1.24,P〈0.05）,the concentration of total cholesterol（mmol/L） increased（6.51±0.84 vs.3.93±1.14,P〈0.05）,the need for invasive mechanical ventilation increased（13/16 vs.11/128,P〈0.05）,the days in hospital were prolonged（35±13 vs.11±3,P〈0.01）,the cost（1000 RMB） increased（32±11 vs.7.6±2.8,P〈0.01）,and the mortality also increased（2/16 vs.3/128,P〈0.01）.Conclusion AMI should be alerted in the case of sudden exacerbation of chest tightness and dyspnea in elderly patients with AECOPD.
出处
《中国呼吸与危重监护杂志》
CAS
2010年第6期627-630,共4页
Chinese Journal of Respiratory and Critical Care Medicine
关键词
慢性阻塞性肺疾病
心肌梗死
感染
呼吸衰竭
Chronic obstructive pulmonary disease Myocardial infarction Infection Respiratory failure
