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目的探讨导致急性心肌梗死院内死亡的相关危险因素。方法总结437例急性心肌梗死患者资料,分为院内死亡组(29例)及存活组(408例),对比临床资料,分析年龄、入院时心功能Killip分级、入院时心率、及非心脏合并症等情况,并分析29例院内死亡病例的死亡直接原因。结果死亡组年龄>70岁,入院时心功能Killip分级在>Ⅱ级,入院时心率>100次/分,前壁心肌梗死,新发的阵发性心房颤动/心房扑动较对照组有显著性差异(P<0.05)。多因素Logistic回归分析表明,年龄>70岁(P=0.0104,OR=4.68,95%CI1.286～15.792)、入院时心功能Killip>Ⅱ级(P=0.0072,OR=6.93,95%CI1.647～19.314)、前壁心肌梗死(P=0.0247,OR=3.81,95%CI 1.165～11.389)、新发的阵发性心房颤动/心房扑动(P=0.0169,OR=5.26,95%CI1.401～16.129)是急性心肌梗死院内死亡的独立危险因素。在29例死亡病例中,心源性休克导致死亡的病例是16例(55%),心脏破裂导致死亡的病例是11例(38%)。结论年龄>70岁、入院时心功能Killip>Ⅱ级、前壁心肌梗死、新发的阵发性心房颤动/心房扑动是急性心肌梗死院内死亡的独立危险因素。
Objective To explore the related risk factors of nosocomial death in acute myocardial infarction. Methods A total of 437 patients with acute myocardial infarction were included in this study. The data were divided into nosocomial death group (n = 29) and survival group (n = 408). Clinical data were compared between the two groups. Age, Killip classification, admission heart rate and noncardiac complications Etc., and analyzed the direct causes of death in 29 hospitalized death cases. Results The death group was over 70 years old. The Killip scores were> grade Ⅱ on admission, heart rate> 100 beats per minute on admission, myocardial infarction in the anterior wall and paroxysmal atrial fibrillation / atrial flutter were significant Sex differences (P <0.05). Multivariate logistic regression analysis showed that the Killip> Ⅱ level (P = 0.0072, OR = 6.93, 95% CI1) was significantly higher at the age of 70 years (P = 0.0104, OR = 4.68, 95% CI1.286 to 15.792) 647 ~ 19.314), anterior myocardial infarction (P = 0.0247, OR = 3.81, 95% CI 1.165-11.389), new paroxysmal atrial fibrillation / atrial flutter (P = 0.0169, OR = 5.26,95% CI1 .401 ~ 16.129) were independent risk factors of nosocomial death in acute myocardial infarction. Among the 29 deaths, 16 (55%) died of cardiogenic shock and 11 (38%) died of cardiac rupture. Conclusion Age> 70 years old, admission Killip> Ⅱ level, anterior myocardial infarction, paroxysmal atrial fibrillation / atrial flutter is an independent risk factor for nosocomial death in acute myocardial infarction.