摘要
目的探讨急性心肌梗死(AMI)合并消化道出血患者的临床特点及预后情况。方法选择我院心内科在2012年4月~2013年4月收治的193例患者作为研究对象,按照疾病类型分为三组,A组为未发生消化道出血的AMI患者,共100例,B组为AMI后发生消化道出血的患者,共52例,C组为消化道出血后发生AMI的患者,共41例。观察三组患者的生化指标及临床治疗差异,随访2年后,比较三组患者再发循环系统功能障碍疾病(包括再发心绞痛、心力衰竭、非致死性AMI等)的情况及死亡率。结果三组患者的生化指标及临床治疗情况存在较大差异;B、C组患者的肾小球滤过率(EGFR)显著低于A组,B、C组患者的活化部分凝血活酶时间(APTT)长于A组,B、C组患者的血红蛋白(Hb)值明显低于A组,且上述差异均有统计学意义(P<0.05)。三组患者使用阿司匹林及氯吡格雷等抗凝药物的比例均互不相同,且差异均有统计学意义(P<0.05);B、C组患者均有消化道出血,B组输血患者的比例远远低于C组,差异有统计学意义(P<0.05)。经过2年的跟踪随访,发现B、C组再发循环系统功能障碍疾病的患者比例和死亡率高于A组,差异有统计学意义(P<0.05)。结论合并消化道出血的AMI患者的临床表现比单纯的AMI患者更加复杂,抗凝治疗更加困难,且再发风险大,预后差。
Objective To explore the clinical features and prognosis of patients with acute myocardial infarction （AMI） complicated with gastrointestinal bleeding.Methods 193 patients treated in our department of cardiology from April 2012 to April 2014 were selected as research objects.According to the disease types,the patients were divided into three groups：group A （AMI without gastrointestinal bleeding）,totally 100 cases,group B（gastrointestinal bleeding following AMI）,totally 52 cases,group C（AMI following gastrointestinal bleeding）for after patients,totally 41 cases.The difference of biochemical indexes and clinical tmeament among three groups were observed.After two,years follow-up,the recurrence （including angina pectoris,heart failure,nonfatal AMI,etc.）and mortality of the three groups were compared.Results The biochemical indicators and clinical treatment of patients in three groups differed greatly from each other;glomerular fil- tration rates of group B and C were significantly lower than that of group A,and activated partial thromboplastin time （APTT） of group B and C was longer than that of group A,and hemoglobin of group B and C was lower than that of group A,and these differences were statistically significant（P〈0.05）.The use of anticoagulant drug in three groups such as As- pirin and Clopidogrel were differed from each other, and differences were statistically significant （P〈O.05）.Ahhough pa- tients in group B and C both were with gastrointestinal bleeding,patients in group B needed less blood transfusion than that in group C,and difference was statistically significant （P〈0.05）.After two-years follow-up,the recurrence of circulato- ry dysfunction diseases and mortality of group B and C were more than those of group A,and differences were statistical- ly significance （P〈0.05）.Conclusion AMI patients complicated with gastrointestinal bleeding have more clinical fea- tures,need more complex anticoagulant treatment,suffer more risks of recurrence,and have worse prognosis than AMI patients without gastrointestinal bleeding.
出处
《中国当代医药》
2017年第7期47-49,共3页
China Modern Medicine
关键词
急性心肌梗死
消化道出血
临床特点
预后情况
Acute myocardial infarction
Gastrointestinal bleeding
Clinical feature
Prognosis
