老年急性冠脉综合征转归与气候变化关系的研究

发布时间：2018-05-07 09:17

本文选题：冠状动脉疾病 + 季节　；参考：《天津医科大学》2013年硕士论文

【摘要】：目的：探讨天津市季节变化和气象因素对老年急性冠状动脉综合征转归情况的影响,找出对患者病死率较高的季节、主要气象因素及高风险人群,制定相应的措施来降低老年急性冠状动脉综合征患者的病死率,提高好转率。方法：住院且诊断明确的1701例急性冠状动脉综合征患者,按入院季节和气象因素分组,分析研究对象的性别、年龄、个人史、既往史、入院时情况和转归情况,对死亡患者的年龄分层进行亚组分析。结果：急性冠状动脉综合征病死率在春季为15.6%(71/456),夏季为8.5%(26/305),秋季为10.1%(42/417),冬季为16.6%(87/523),其差异有统计学意义(P0.01),冬季比夏秋季病死率高(P0.05),春季比夏季病死率高(P0.05)。与夏季相比春冬季死亡的患者年龄较高(P0.05)。既往有高血压者在冬季比夏秋季的病死率高(P0.05),有冠心病者在秋冬季的病死率比春夏季高(P0.05),ST段有明显改变的病死率冬季比春季高(P0.05)。急性冠脉综合征患者的转归情况在日平均气温的分布差异有统计学意义(χ2=48.2235,P0.05)。日平均气温小于6℃时,急性冠脉综合征患者的病死率较6-30℃时高(P0.05)；24小时温差大于14℃时比小于14℃时有较高的病死率(χ2=4.2718,P=0.0388,P0.05)和较低的好转率(χ2=7.7361,P=0.0054,P0.01)。患者的转归情况在日平均气压的分布差异有统计学意义(χ2=58.90563,P0.05)。日平均气压小于1000hPa时,患者的病死率比日平均气压在1000-1030hPa时的病死率高(P0.05);24小时气压差大于5hPa时,急性冠脉综合征患者的病死率较高,好转率较低(P0.05)。急性冠脉综合征患者的转归情况在日平均风速和日平均相对湿度的分布差异无统计学意义。各年龄分层中,老老年患者的死亡人数最多(54.0%),年轻老年的次之(39.8%),长寿老年的最少(6.1%),但当日平均气温大于30℃和日平均气压小于1000hPa时,年轻老年的死亡人数较多(P0.05)。二元logistic回归分析显示季节(OR=1.169,P=0.044,OR值95%CI=1.00～1.360)、冠心病病史(OR=1.536, P=0.033, OR值95%CI=1.036～2.279)、年龄(OR=1.050, P=0.000, OR值95%CI=1.022-1.078)、ST段明显改变(OR=1.533,P0.05,OR值95%CI=1.070-2.195)、24小时温差(OR=4.038,P=0.037,OR值95%CI＝1.089-8.41)、24小时气压差(OR=2.057,P=0.036,OR值95%CI=1.051-4.031)为急性冠状动脉综合征病死率的危险因素。结论：四季中患者的急性冠脉综合征患者的转归情况不同,病死率有高有低,春冬季的病死率较高,患者年龄越高,死亡风险越大,以春冬季为著。各气象因素会影响急性冠脉综合征患者的转归情况,日平均气温较低时、24小时温差较大时、日平均气压较低时和24小时气压差较大时,急性冠脉综合征患者的病死率较高,好转率较低。年轻老年较老老年和长寿老年的转归情况更易受高温和低气压的影响,并且有较多的死亡例数。季节变化、年龄、冠心病史、ST明显改变、24小时温差及气压差为急性冠脉综合征患者死亡的独立危险因素。合并有冠心病、高血压、ST段改变明显的急性冠脉综合征患者在季节和气象因素的变化中为高风险死亡人群。
[Abstract]:Objective: To explore the effects of seasonal and meteorological factors on the prognosis of elderly patients with acute coronary syndromes in Tianjin, and to find out the seasons with high mortality rate, main meteorological factors and high risk population, and formulate corresponding measures to reduce the mortality of the elderly patients with acute coronary syndromes and improve the rate of improvement. In 1701 patients with acute coronary syndrome, the sex, age, personal history, past history, hospitalization and prognosis were analyzed, and the age stratification of the patients was analyzed. Results: the mortality rate of acute coronary syndromes was 15.6% (71/45 6) in summer, 8.5% (26/305), 10.1% (42/417) in autumn and 16.6% (87/523) in winter (P0.01), higher in winter than in summer and autumn (P0.05), higher in spring than in summer (P0.05). The mortality of those who died in spring and winter compared with summer was higher (P0.05). The fatality rate of those with past hypertension was higher in winter than in summer and autumn (P0.). 05), the mortality of patients with coronary heart disease in autumn and winter was higher than that in spring and summer (P0.05), and the mortality of ST segment was significantly higher in winter than in spring (P0.05). The distribution of patients with acute coronary syndrome was statistically significant (x 2=48.2235, P0.05). The average daily temperature was less than 6 C, the disease of patients with acute coronary syndrome was ill. The mortality rate was higher than that of 6-30 C (P0.05); higher mortality rate (x 2=4.2718, P=0.0388, P0.05) and lower improvement rate (x 2=7.7361, P=0.0054, P0.01) were higher when the temperature difference of 24 hours was greater than 14 C and lower (x 2=7.7361, P=0.0054, P0.01). The distribution difference of daily mean pressure in the patient was of general significance (x 2=58.90563, P0.05). The daily mean pressure was less than 1000hPa, The fatality rate of the patients was higher than that of the daily mean pressure of 1000-1030hPa (P0.05); when the 24 hour pressure difference was greater than 5hPa, the mortality of the patients with acute coronary syndrome was higher and the rate of improvement was lower (P0.05). There was no significant difference in the distribution of the average daily wind speed and the daily average relative humidity in the patients with acute coronary syndrome. In the age stratification, the number of dead elderly patients was the most (54%), the next (39.8%) and the least (6.1%) for the elderly, but the average air temperature was greater than 30 and the daily average pressure was less than 1000hPa, and the number of young people died more (P0.05). Two yuan logistic regression analysis showed that the season (OR=1.169, P=0.044, OR value 95%CI=1.00 ~) 1.360), the history of coronary heart disease (OR=1.536, P=0.033, OR value 95%CI=1.036 ~ 2.279), age (OR=1.050, P=0.000, OR value 95%CI=1.022-1.078), ST segment obviously changed (OR=1.533, P0.05, OR value), 24 hour temperature difference, 24 hour pressure difference is acute Conclusions: the risk factors of the mortality of coronary syndrome. Conclusion: the prognosis of patients with acute coronary syndrome in the four seasons is different, the mortality rate is high, the mortality rate is higher in spring and winter, the higher the patient's age, the greater the risk of death, in spring and winter, the weather factors will affect the prognosis of the patients with acute coronary syndrome. When the average temperature is low, when the temperature difference between 24 hours is larger, the average daily pressure is lower and the 24 hour pressure difference is larger, the mortality rate of the patients with acute coronary syndrome is higher and the improvement rate is lower. The prognosis of the younger elderly and the elderly is more susceptible to the influence of high temperature and low pressure, and there are more deaths and seasons. Age, history of coronary heart disease, ST changes, 24 hour temperature difference and pressure difference are independent risk factors for the death of patients with acute coronary syndrome. Patients with coronary heart disease, hypertension, and ST segment changes in acute coronary syndromes have high risk of death in seasonal and meteorological factors.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R543.3;R122.26

【参考文献】