老年患者急性心肌梗死后左心室功能不全的多因素分析  

Multivariate analysis of left ventricular insufficiency after acute myocardial infarction in the aged patients

作　　者：王洁[1] 盖鲁粤[2] 杜洛山[3] 姚晨[4] 

机构地区：[1]中国人民解放军总医院老年心血管科,北京100853 [2]中国人民解放军总医院心脏内科,北京100853 [3]中国人民解放军总医院心导管室,北京100853 [4]中国人民解放军总医院统计教研室,北京100853

出　　处：《中华老年心脑血管病杂志》2000年第4期233-236,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的　探讨老年患者急性心肌梗死后发生心功能不全的相对独立的危险因素 ,为强化老年急性心肌梗死患者的治疗及二级预防提供依据。方法　回顾性分析我院 1988年 1月至 1998年 6月住院的急性心肌梗死并行冠状动脉造影检查的老年患者。用Logistic和Cox模型分析持续存在的冠心病危险因素和与梗死相关的因素对是否在发生心功能不全和梗死后多长时间发生心功能不全这二个方面的影响。结果　 6 9例老年患者中男 5 8例 ,女 11例 ,平均年龄 (70± 3)岁。参与分析 49例 ,其中心源性死亡 4例 (占 8.2 % ) ,心功能不全占 2 3例 (46 .9% )。老年患者急性心肌梗死后随时间的推移 ,发生心功能不全的概率逐年增高 ,梗死后 8～ 9年最明显。高龄、糖尿病是老年患者心肌梗死后是否发生心功能不全的相对独立危险因素。高龄、高血压是加速老年患者急性心肌梗死后发生心功能不全的危险因素。经皮腔内冠状动脉成形术是阻止和延缓老年心肌梗死后发生心功能不全的有效干预治疗。大面积心肌梗死及多次心肌梗死、多支血管病变是老年心肌梗死后发生心功能不全的相对独立的、有意义的影响因素。结论　加强老年患者急性心肌梗死后的再血管化治疗及有效的控制老年高血压、糖尿病 ,可阻止和延缓老年急性心肌梗死后发生心功能不全。Objective To investigate factors contributing to left ventricular insufficiency (LVI) in the aged patients who had survived acute myocardial infarction (AMI).Methods Retrospective analysis of all hospitalized aged patients with AMI who underwent coronary angiography from 1988 to 1998 was performed.The patients' data were entered into the SAS and the logistic and Cox model regression analyses were performed.Results Of the 69 aged patients collected,49 met the entry criteria.Four of them (8.2%) died of cardiac events and 23 (46.9%) had LVI diagnosed by echocardiography after discharge during the ten year follow up period.The probability of LVI in the aged patients with AMI increased with time,dramatically increased 8～9 years after AMI.In the logistic regression analysis,the following factors appeared to be the significant independent predictors of the LVI after AMI in the aged patients:age(P=0.0019,RR=1.8),diabetes  (P= 0.0166,RR=32.0),size of infarction (P=0.0173,RR=12.9),the number of diseased vessels (P=0.0047,RR=4.8),PTCA (P= 0.0059,RR=0.0609).In the Cox regression analysis,the following factors appeared to be the significant independent predictors of the LVI after AMI in the aged patients:age (P=0.0245,RR=1.3),hypertension  (P= 0.0001,RR=2.9),PTCA (P=0.002,RR=0.213).Conclusions Aged patients with advanced age,diabetes,hypertension,large infarct,reinfarction,multivessel disease and without PTCA are prone to develop LVI after AMI.It is recommended that secondary prevention and complete revascularization be done to prevent heart failure after AMI in the aged patients.

关 键 词：老年人 心肌梗塞 心室功能障碍 左 回归分析 危险因素 

分 类 号：R542.2[医药卫生—心血管疾病]