摘要
目的分析不同年龄急性ST段抬高型心肌梗死（STEMI）患者的再灌注延迟时间分布,探讨不同年龄组之间的差异。方法选取2011年7月至2015年10月急诊收治并符合入选标准的STEMI患者309例,根据年龄分为3组,年龄≥75岁组（n=32）、60~74岁组（n=118）与年龄≤59岁组（n=159）,分析各急救时间分布,包括发病至首次医疗接触时间（SO-to-FMC）、转运时间、首次医疗接触到再灌注（FMC-to-B）、导管室启动延迟时间、介入操作延迟时间、急诊至球囊扩张血管再通时间（D-to-B）,并观察其临床预后。结果年龄≥75岁组患者合并高血压病、多支病变者及高Killip分级者比例较高;与年龄≤59岁组比较,年龄≥75岁组STEMI患者30 d和1年内的死亡率和总主要不良心脑血管事件（MACCE）发生率均明显增高,差异有统计学意义（P〈0.05）;年龄≥75岁组与年龄≤59岁组比较,在转运延迟时间上增加,差异有统计学意义（P〈0.05）,其余各项指标差异均无统计学意义（P〉0.05）。结论年龄≥75岁高龄患者合并症多、临床预后差,年龄因素可能是影响院前延迟的重要原因。
Objective To explore the analysis of different ages of reperfusion delay time distribution in patients with acute ST segment elevated myocardial infarction （ STEMI）, and the differences in different age groups. Methods A total of consecutive 309 patients with STEMI were analyzed in the 306th Hospital of PLA from July 2011 to October 2015. Patients were divided into three groups： ≥75 years group（n =32） ,60-74 years group（n = 118）and ≤59 years group（n = 159） ,and the hospital care data and the time intervals, including SO-to-FMC time,FMC-to-B time and D-to-B time were compared by different ages. Results Compared with groups ≤ 59 years, ≥75 years group,patients were more likely to have additional comorbidities present and higher Killip class. Left main stem in- volvement or three-vessel disease was significantly more frequent and in the elder patient group. Compared to ≤59 years group pa- tients,the overall mortality and MACCE was significantly higher in ≥75 years group patients, at 30-day（ 12. 5% versus 3.14%, 15. 63 % versus 5. 03 % , P 〈 0. 05 ）and 1-year（ 12. 50% versus 3.14%, 18.75 % versus 6. 92% ）follow-up, respectively. The overall median duration of prehospital delay was 130 minutes（ mean 189. 3 minutes）. In ≥75 years group, the median FMC-to-D times were showed a greater delay（49. 5 minutes versus 35.0 minutes,P 〈 0. 05 ）than ≤59 years or younger patients. No difference was found in prehospital delay,SO-to-FMC,FMC-to-B,D-to-B and total ischemia time（P〉0. 05）. Conclusion Elderly patients（aged≥75 years） with STEMI were more likely to delay seeking timely medical care after the onset of AMI. Factors associated with duration of prehospi- tal delay including age need to be more systematically examined.
出处
《临床军医杂志》
CAS
2016年第5期505-509,共5页
Clinical Journal of Medical Officers
