急性心肌梗死合并多器官功能衰竭53例临床分析  

Clinical analysis of 53 patients with acute myocardial infarction complicated with multi-organ dysfunction syndrome

作　　者：熊日成[1] 赖添顺[1] 俞宙[1] 

机构地区：[1]广州军区广州总医院MICU,510010

出　　处：《实用医学杂志》2009年第11期1790-1793,共4页The Journal of Practical Medicine

摘　　要：目的:探讨急性心肌梗死(AMI)合并多器官功能衰竭(MODS)的临床特点及有效的治疗方法。方法:回顾性分析2003年5月至2008年4月广州军区总医院收治的53例AMI合并MODS的临床资料,比较死亡组(33例)及存活组(20例)的治疗策略差异,并用logistic分析死亡相关的治疗策略。结果:总病死率为62.3%。各组入院时临床特征及合并脏器衰竭情况无显著差异。存活组治疗措施包括双联抗血小板20例(100%)、机械通气17例(85.0%)、接受了PCI治疗16例(80.0%)及强化血糖控制17例(85.0%)。而死亡组患者以上措施的采用率分别为78.8%(26/33)、54.5%(18)、48.5%(16/33)及36.4%(12/33)。两组比较差异有显著性(P<0.05)。而抗凝、早期液体复苏、高通量血滤、白蛋白/血浆、ACEI/ARB及乌司他丁等治疗措施与死亡无相关性。结论:AMI合并MODS病死率高,双联抗血小板、接受了PCI、机械通气、强化血糖控制等治疗策略可明显减少病死率。Objective To explore the clinical features and efficient therapeutic methods for acute myocardial infarction （AMI） complicated with multi-organ dysfunction syndrome （MODS）. Methods The clinical data of 53 patients with AMI and MODS from May 2003 to April 2008 were retrospectively analyzed. The differences of therapeutic strategies were compared between survival group （n = 20） and death group （n = 33）. Risk factors affecting the mortality of patients in terms of treatment were analyzed by Logistic analysis. Results The mortality of 53 patients was 62.3%. There were no significant differences in clinical features and status between the two groups before treatment. Therapeutic strategies adopted in the survival group included anti-platelet with two drugs （20/20,100%）, mechanical ventilation （17/20,85%）, percutaneous coronary interventions （PCI） （16/20,80%）, and intensive insulin therapy （ 17/20, 85%）. The corresponding rates of these therapeutic strategies adopted in the death group were 78.8% （26/33）, 54.5% （18/33）, 48.5% （16/33）, and 36.4% （12/33）, respectively （all P 〈 0.05）. There were no significant correlations between patients＇ death and the following therapeutic strategies, such as anticoagulation, early goal-directed therapy, high-flux hemodialysis, use of albumin/plasma, use of ACEI/ARB, or use of ulinastatin. Conclusion There is a high mortality of AMI complicated with MODS, which can be reduced by anti-platelet with two drugs, PCI, mechanical ventilation, and intensive insulin therapy.

关 键 词：心肌梗塞 多器官功能衰竭 治疗 临床特征 

分 类 号：R542.22[医药卫生—心血管疾病] R459.7[医药卫生—内科学]