论文部分内容阅读
目的探讨最优化药物治疗、急诊经皮冠状动脉介入治疗(PCI)及择期PCI治疗急性心肌梗死(AMI)患者的院内及远期存活情况。方法回顾性分析2006年12月至2016年2月上海长海医院收治的3 238例AMI患者的一般资料、既往病史及家族史、临床检查及诊断、合并症及并发症、治疗方法、院内存活情况及病死原因,并对所有患者进行电话随访,分析其远期存活情况及病死原因。结果本研究中3 238例AMI患者院内病死率为5.8%,其中,药物治疗组患者病死率(26.6%)高于手术组(2.5%);急诊PCI手术组患者病死率(3.5%)高于择期PCI手术组(2.0%)。非心因性是院内病死的首要原因(31.7%),其次是心源性休克(30.2%)。Killips分级、年龄、白细胞水平、室颤、心源性休克是药物治疗组院内病死的独立危险因素;Killips分级、年龄、入院血糖、入院肌钙蛋白、室颤、未使用ACEI/ARB是急诊PCI组院内病死的独立危险因素;既往PCI/CABG史、入院肌酐、室颤、Gensini积分、心源性休克是择期PCI的独立危险因素。2 046例患者获得随访,药物治疗组随访病死率(34.3%)明显高于急诊PCI组(4.6%)和择期PCI组(5.3%);急诊PCI组和择期PCI组随访病死率比较,差异无统计学意义(P>0.05)。结论对于AMI患者,及早行PCI能够提高其在院及远期存活率,应重视心源性休克、恶性心律失常等并发症。针对老年、女性、合并糖尿病的患者,要加强宣教,有助于及早识别AMI,降低病死率。
Objective To investigate the long-term and long-term survival of patients undergoing optimal drug therapy, emergency percutaneous coronary intervention (PCI) and elective PCI for acute myocardial infarction (AMI). Methods The data of 3 238 AMI patients admitted to Shanghai Changhai Hospital from December 2006 to February 2016 were analyzed retrospectively. The past medical history, family history, clinical examination and diagnosis, complications and complications, treatment and survival in hospital were analyzed retrospectively And the cause of death, and all patients were followed up by phone to analyze its long-term survival and cause of death. Results The in-hospital mortality rate of 3,238 AMI patients in this study was 5.8%, of which, the mortality rate was significantly higher in the drug-treated group (26.6%) than in the operative group (2.5%); the mortality rate in the emergency PCI group was 3.5% Elective PCI surgery group (2.0%). Non-cardiac causes were the leading cause of hospital mortality (31.7%), followed by cardiogenic shock (30.2%). Killips grade, age, leukocyte level, ventricular fibrillation and cardiogenic shock were independent risk factors for hospital mortality in the drug treatment group. Killips grade, age, admission blood glucose, admission troponin, ventricular fibrillation, unused ACEI / ARB were emergency PCI The independent risk factors of death in hospital were PCI, history of previous PCI / CABG, admission creatinine, ventricular fibrillation, Gensini score and cardiogenic shock were independent risk factors for elective PCI. The follow-up of 2 046 patients was followed up in the drug treatment group (34.3%), which was significantly higher than the emergency PCI group (4.6%) and elective PCI group (5.3%). The follow-up mortality rates between the emergency PCI group and the elective PCI group were significantly different Statistical significance (P> 0.05). Conclusion For patients with AMI, PCI can improve the survival rate in hospital and long-term, should pay attention to complications such as cardiogenic shock, malignant arrhythmia. For the elderly, women, patients with diabetes, to strengthen the mission to help identify AMI early and reduce mortality.