再次心肌梗死发生的高危因素分析  

Analysis on high-risk factors for second heart attack after acute myocardial infarction

作　　者：李志刚[1] 

机构地区：[1]白银市第一人民医院,甘肃白银730900

出　　处：《中国中西医结合急救杂志》2011年第1期38-40,共3页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

摘　　要：目的探讨急性心肌梗死（心梗）发生后患者发生再次心梗的高危因素。方法选择急性心梗经静脉溶栓治疗后的65例患者，其中21例发生再次心梗为观察组，44例未发生再次心梗为对照组。观察两组患者首次心梗发生部位、发病至开始溶栓时间、酶峰出现时间、血脂水平变化、心梗后抗凝治疗、心绞痛的发生、个人生活方式等与再次心梗发病率的关系。结果与对照组比较，观察组首次心梗发生在下壁的比例高[61．9％（13／21）比38．6o,4（17／44）]，发病至开始溶栓时间及酶峰出现时间明显延长[（60．7土18．2）min比（30．2±12．1）min，（14．2±1．7）h比（12．2±1．5）h]，总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL—C）均明显升高[TC（mmol／L）：5．41±2．72比4．12土1．98，TG（mmol／L）：1．88±0．81比1．41±0．75，LDL—C（retool／L）：4．12±1．71比2．11±1．823，高密度脂蛋白胆固醇（HDL-C）则明显降低[HDL—C（mmol／L）：1．72±0．82比2．94±0．71]，观察组患者不能长期坚持抗凝治疗，凝血酶原时间（PT）及活化部分凝血活酶时间（APTT）明显缩短[PT（8）：11．1±4．2比20．3±5．3，APTT（s）：13．5±63．5比24．2±6．83，心绞痛发生率明显升高（52．4％比29．5％），心理健康人数的比例及每日参加适量运动人数的比例均明显降低（38．1％比70．5％，33．3％比72．7％），差异均有统计学意义（均P〈0．05）。结论再次心梗的发生与首次心梗发生部位、发病至开始溶栓时间、酶峰出现时间、血脂水平、心梗后抗凝治疗、心绞痛的发生、个人生活方式等因素均有密切的关系。Objective To investigate the high-risk factors of patients with a second heart attack after acute myocardial infarction （AMI）. Methods Sixty-five survival cases with AMI undergoing intravenous thrombolysis were enrolled, of them, in 21 cases the second myocardial infarction occurred （observation group）, and in 44 cases, that did not occur （control group）. The position of myocardial infarction at the first time, the duration between the occurrence of morbidity and the beginning of receiving the thrombolysis, the time of appearance of enzyme peak, changes of blood lipid levels, and after treatment, the maintenance situ- ation of anticoagulation, the occurrence of angina pectoris, personal lifestyle, etc factors were compared between the two groups, and their correlations with the occurrence of the second AMI were analyzed. Results Compared with the control group, in the observation group, the proportion of the first AMI at the cardiac lower wall was higher [61.9% （13/21） vs. 38.6%（17/44）3, the duration between the occurrence of morbidity and the beginning of receiving the thrombolysis and the time of appearance of enzyme peak were longer obviously （（60.7 ± 18.2） minutes vs. （30. 2 ± 12.1） minutes, （14.2 ± 1.7） hours vs. （12.2 ± 1.5） hours the total cholesterol （TC）, triglyceride （TG）, low density lipoprotein cholesterol （LDL-C） were obviously elevated （TC （mmol/L） ： 5.41 ±2.72 vs. 4.12 ±1.98, TG （mmol/L） ： 1.88 ± 0.81 vs. 1.41±0. 75, LDL-C （mmol/L） ： 4.12±1.71 vs. 2.11±1. 823, while the high density lipoprotein cholesterol （HDL-C）was reduced markedly [HDL-C （retool/L） ： 1.72±0.82 vs. 2.94±0. 713, in observation group, the patients could not insist on applying long-term anticoagulation treatment, their prothrombin time （PT） and activated partial thromboplastin time （APTT） were shortened significantly [PT （s）.. 11.1±4.2 vs. 20.3±5.3, APTT （s） ： 13.5± 63.5 vs. 24±6.83 ; the incidence of angina pectoris was

关 键 词：心肌梗死 急性 高危因素 病死率 

分 类 号：R256.2[医药卫生—中医内科学] R542.2[医药卫生—中医学]