天津市季节变化与老年急性冠状动脉综合征病死率的关系  

Relationship of seasonal variation and mortality of elderly people with acute coronary syndrome in Tianjin

作　　者：王罗莎[1] 王林[1] 封锐[1] 黄姣红[1] 郭晓坤[1] 郭世杰[1] 

机构地区：[1]天津医科大学第二医院干部保健科,天津300211

出　　处：《临床荟萃》2013年第5期502-504,508,共4页Clinical Focus

摘　　要：目的探讨天津市季节变化对老年急性冠状动脉综合征病死率的影响,找出病死率较高的季节及高风险人群,制定相应的措施降低老年急性冠状动脉综合征患者的病死率。方法住院且诊断明确的1 701例急性冠状动脉综合征患者,按入院季节分组,分析研究对象性别、年龄、个人史、既往史、入院时情况和病死率。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(P<0.01),冬季比夏秋季病死率高(P<0.05),春季比夏季病死率高(P<0.05)。与夏季相比春冬季死亡的患者年龄较高(P<0.05)。既往有高血压者在冬季比夏秋季的病死率高(P<0.05),有冠心病者在秋冬季的病死率比春夏季高(P<0.05),ST段有明显改变的病死率冬季比春季高(P<0.05)。二元logistic回归分析显示季节(OR=1.169,P<0.05,OR值95%CI=1.00～1.360)、冠心病病史(OR=1.536,P<0.05,OR值95%CI=1.036～2.279)、年龄(OR=1.050,P<0.01,OR值95%CI=1.022～1.078)、ST段明显改变(OR=1.533,P<0.05,OR值95%CI=1.070～2.195)为急性冠状动脉综合征病死率的危险因素。结论四季中患者的病死率高低不同,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,合并有高血压、ST段改变明显的患者在冬季为高风险人群,有冠心病的患者在秋冬季为高风险人群。Objective To investigate the effects of variation and mortality of elderly patients with acute coronary syndrome in Tianjin to identify high mortality season and high-risk populations, and to make appropriate measures to reduce mortality. Methods 1 701 cases of acute myocardial infarction who were hospitalized in the hospital had clear diagnosis and complete information were collected and reviewed retrospectively. All cases were divided with seasons into different groups. Gender, age, personal history, past history and clinical data were analyzed. Results The mortality with acute coronary syndrome was significantly different（ P 〈0.01）, spring 15.6% （71/456）, summer 8.5% （26/305）, autumn 10.1%（42/417） and winter 16.6% （87/523）. A higher mortality rate was shown in winter compared with summer and autumn（ P 〈0.05）. Mortality of spring was higher than that of summer（ P 〈0.05）. More old patients died in winter and spring than in summer（ P 〈0.05）. Previously hypertensive patients had higher mortality in summer and winter（ P 〈0.05） ,and patients associated with coronary heart disease had higher mortality in autumn and winter（ P 〈0.05）. Died patients who had obvious change of ST segment were more common in winter than in spring（ P 〈0.05）. Binary logistic regression analysis revealed that season（ OR = 1. 169, P d0.05, OR 95 % CI = 1.00-1. 360）, coronary heart disease history（ OR = 1. 536, P 〈0.05, OR 95 % CI = 1. 036-2. 279）, age（ OR = 1. 050, P 〈0.01, OR 95% （71 =1. 022-1. 078） ,and ST segment obviously change（ OR =1. 533, P d0.05, OR 95% CI =1. 070-2. 195） for the mortality of acute coronary syndrome were risk factors. Conclusion The mortality in the patients is different in four seasons. The higher mortality occurs in spring and winter. The higher age, the greater risk of death, the difference was significant in spring and winter. Patients combined with hypertension and obvious changes of ST segment are higher risk population in winter. Pat

关 键 词：冠状动脉疾病 季节 死亡率 老年人 

分 类 号：R541.4[医药卫生—心血管疾病]