80岁以上老年人急性心肌梗死近期预后多因素分析
心肌梗死；,预后；,老年人,【主题词】心肌梗死；预后；老年人,1对象与方法,2结果,3讨论,参考文献
【摘要】 目的 探讨≥80岁老年人急性心肌梗死(AMI)近期(30 d内)预后的影响因素。 方法 以1993年1月至2002年8月收住解放军总医院冠心病监护病房123例≥80岁AMI患者为对象，对比分析近期病死组(26例)与存活组(97例)患者的病史、临床表现、并发症等特点，以Logistic多因素逐步回归分析探讨高龄AMI近期死亡的影响因素。 结果 单因素分析显示病死组糖尿病、陈旧性心肌梗死、脑梗死、血白细胞计数≥10×109/L、左室射血分数≤50%、并发泵衰竭、心律失常、肺炎者多(P<005或P<001)；应用阿司匹林治疗者少(P<005)。Logistic多因素逐步回归分析表明，糖尿病、脑梗死病史、合并泵衰竭是高龄AMI近期死亡的独立影响因素，比数比和950%可信限分别为358，108～1190和682，155～2998及1311，384～4478。 结论 ≥80岁AMI患者并存糖尿病、脑梗死和并发泵衰竭是近期预后的独立危险因素。【主题词】 心肌梗死； 预后； 老年人
Impact factors of shortterm prognosis in very elderly patients aged 80 years or older with acute myocardial infarction
ZHAO Yusheng， LIU Guanghua, YIN Qiaoxiang, FENG Bin, WANG Shiwen.
Institute of Geriatric Cardiology, Chinese PLA General Hospital, Beijing 100853 China
【Abstract】 Objective To investigate the impact factors of shortterm prognosis in very elderly patients aged 80 years or older with acute myocardial infarction(AMI). Methods One hundred and twentythree very elderly patients with AMI were admitted to the Chinese PLA General Hospital from January 1, 1993 to August 31, 2002 respectively. Patients were divided into two groups. The clinial characteristics, risk factors, clinical treatment and complications were analyzed. Resukts Twentysix patients died of AMI within 30 days. Univariate analysis indicated that histories of diabetes, prior MI and cerebral infarction, high white blood cells account(≥10×109/L), low left ventricular ejection fraction(≤ 50%), inhospital complications including arrhythmia, pump failure and pneumonia, as well as the therapy without aspirin were significantly associated with the inhospital mortality within 30 days. Multivariate logistic regression analysis using mortality as the dependent variable and the history, inhospital complication and so on as the independent variable showed that the major determinants of the inhospital mortality were the histories of diabetes [odds ratio 358, 95% confidence interval (CI) 108 to 1190] ......
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