摘要
目的研究急性心梗患者院内死亡的相关影响因素,为降低急性心梗院内死亡的风险提供理论依据。方法利用调查表收集20家医院共2203例急性心梗患者的病历信息,对急性心梗患者院内死亡的相关因素进行单因素χ2检验和两水平logistic回归分析。结果单因素分析结果显示:性别、年龄、糖尿病、心衰、心源性休克、心律失常、心功不全对急性心梗院内死亡的影响有统计学意义;两水平logistic模型分析显示:院内死亡存在医院效应;在调整患者水平因素的影响后,不同医院急性心肌梗死患者的病死率不同;扣除医院效应后,两水平模型分析发现:65岁以上急性心梗患者病死率高;合并高血压或心衰的急性心梗患者死亡风险分别是未合并患者的1.87、1.93倍;并发心源性休克的死亡风险高于未并发的患者;前壁梗死的死亡风险高于其他部位梗死。结论 65岁以上人群、合并高血压、合并心衰是急性心梗院内死亡的高危人群;急性心梗部位是前壁梗死、并发心源性休克的患者应重点加以关注并及时采取针对性措施,以降低其死亡风险;急性心梗患者的院内死亡不仅与患者个体水平因素有关,还存在不可忽略的医院效应。
Objective To study relative factors which affected AMI hospital death,in order to provide a theoretical basis for reducing the risk of hospital mortality of acute myocardial infarction.Methods Designed questionnaire was used to collect medical records for 2203 AMI patients in twenty hospitals,chi-square test was used in univariate analysis,two-level logistic model was used to analyze the risk factors for hospital mortality of AMI patients.Results Chi-square test showed: gender,age,diabetes,heart failure,cardiogenic shock,arrhythmias,cardiac dysfunction influenced AMI patients hosptial death significantly.Two-level logistic model indicated: hospital effect existed;adjusted for patient level factors,mortality distributed differently among the twenty hospitals;balancing the hospital effect,two-level model indicted: hospital mortality was higher for AMI patients aged over sixty-five years;The risk of death for AMI patients with hypertension or heart failure was 1.87,1.93 times higher than that of patients without hypertension or heart failure respectively.The hospital mortality of AMI patients with cardiogenic shock was highter than that of patients without cardiogenic shock.The death risk of Anterior wall infarction was higher than other parts infarction.Conclusion The elders over 65 years,patients with hypertension and patients with heart failure were high risk poplutions of hospital death of AMI patients.Specific measures should be taken timely to reduce the risk of death in patients with anterior wall infarction or cardiogenic shock.Hospital mortality of AMI patients was associated not only with patient level factors,but also with hospital effect that can not be ignored.
出处
《中国卫生统计》
CSCD
北大核心
2013年第4期496-498,共3页
Chinese Journal of Health Statistics
基金
国家自然科学基金项目(70873031)
