急性ST段抬高性心肌梗死患者住院死亡率及相关因素分析

发布时间：2018-05-16 18:48

本文选题：急性ST段抬高性心肌梗死 + 住院死亡率　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:研究STEMI住院患者的入院一般情况、既往病史、辅助检查、治疗情况及并发症的情况,分析STEMI患者住院死亡率及相关因素,为临床治疗提供指导。方法:搜集吉林大学白求恩第一医院心内科2014.06.01-2015.12.31住院诊断为STEMI病历2766例。其中死亡患者132例,存活患者2634例。首先分析总体STEMI患者性别、年龄、再灌注治疗情况以及心梗部位与住院死亡率的关系。其次选取病史资料完整的死亡患者109例作为死亡组,同时以死亡组患者的年龄(±10岁)、性别、住院时间(±3月)以及心梗部位来匹配,并按照1:4的方案随机化选择符合条件的存活患者436例作为存活组,然后分析两组患者既往病史,生命体征、辅助检查,治疗情况、并发症的差异。结果:1、本研究纳入STEMI患者总体住院死亡率4.8%(132/2766)。在年龄方面,老年组住院死亡率高于青年组和中年组。在性别方面,女性住院死亡率高于男性。在治疗方面,保守组住院死亡率高于急诊PCI组和择期PCI组。在心梗部位方面,广泛前壁心梗组住院死亡率高于其他部位心梗组高,下壁、右室、正后壁心梗组住院死亡率和前间壁心梗组低于其他部位心梗组。2、单因素分析死亡组和存活组患者在心率、收缩压、舒张压、Killip分级、心功能EF值、CKMB值、入院随机血糖、血肌酐、白细胞、中性粒细胞绝对值、嗜酸性粒细胞绝对值、红细胞分布宽度、心力衰竭、心源性休克、机械性并发症、心律失常、室速、室颤、三度房室传导阻滞、完全性右束支传导阻滞、双联抗血小板药物、β受体阻滞剂、ACEI/ARB、他汀类调脂药、利尿剂的方面差异有统计学意义。3、多因素COX回归分析,结果显示:Killip分级、室颤、完全性右束支传导阻滞、机械性并发症是STEMI住院死亡的独立危险因素。结论:1、急诊PCI或择期PCI治疗可以显著降低STEMI患者住院死亡率。2、急性广泛前壁心肌梗死患者较其余部位心肌梗死组发生住院死亡的风险高。3、入院Killip分级、室颤、完全性右束支传导阻滞、机械性并发症是STEMI患者住院死亡的独立危险因素。
[Abstract]:Objective: to study the general condition, past medical history, adjuvant examination, treatment and complications of STEMI inpatients, to analyze the mortality rate and related factors of STEMI patients, and to provide guidance for clinical treatment. Methods: 2766 cases of STEMI in Department of Cardiology, Bai Qiuen first Hospital, Jilin University were collected from January to December 31, 2014.06.01-2015.12. Among them, 132 died and 2634 survived. First, the sex, age, reperfusion status and the location of myocardial infarction in patients with STEMI were analyzed. 109 patients with complete history were selected as the death group. The age (卤10 years), sex, length of stay (卤3 months) and myocardial infarction site of the patients in the death group were matched. According to the 1:4 scheme, 436 patients were randomly selected as survival group. The differences of past medical history, vital signs, adjuvant examination, treatment and complications between the two groups were analyzed. Results: 1, this study included the overall hospital mortality rate of STEMI patients (4.82 / 2766). In terms of age, the inpatient mortality rate in the elderly group was higher than that in the young and middle age group. In terms of gender, female hospital mortality is higher than male. In treatment, the mortality rate of conservative group was higher than that of emergency PCI group and selective PCI group. In terms of myocardial infarction, the mortality rate of patients with extensive anterior myocardial infarction was higher than that of other myocardial infarction groups. The mortality rate in patients with positive posterior myocardial infarction and anterior myocardial infarction group was lower than that in other myocardial infarction groups. Univariate analysis showed that patients in death group and survival group had heart rate, systolic blood pressure, diastolic blood pressure and Killip grade, cardiac function EF value and CK-MB value, admission random blood glucose, serum creatinine. WBC, neutrophil absolute value, eosinophil absolute value, erythrocyte distribution width, heart failure, cardiogenic shock, mechanical complications, arrhythmia, ventricular tachycardia, ventricular fibrillation, three degree atrioventricular block, Complete right bundle branch block, double antiplatelet drugs, 尾 -receptor blocker ACEI / ARB, statins, diuretics were significantly different. Multivariate COX regression analysis showed that: Killip grade, ventricular fibrillation, ventricular fibrillation (VF), ventricular fibrillation (VF). Complete right bundle branch block and mechanical complications were independent risk factors for hospital death in STEMI. Conclusion: emergency PCI or selective PCI therapy can significantly reduce the mortality rate of STEMI patients. The risk of hospital death in patients with acute extensive anterior wall myocardial infarction is higher than that in other myocardial infarction patients. The hospitalization Killip grade and ventricular fibrillation are also found in patients with acute extensive anterior wall myocardial infarction. Complete right bundle branch block and mechanical complications are independent risk factors for hospital death in STEMI patients.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R542.22

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