成都地区老年急性ST段抬高型心肌梗死患者临床特征和治疗现状调查  

Clinical characteristics and treatment of elderly acute STEMI patients in Chengdu area

作　　者：朱峰[1] 成联超 叶滔 崔彩艳 张玉玫 李思艺 刘汉雄 蔡琳 Zhu Feng;Cheng Lianchao;Ye Tao;Cui Caiyan;Zhang Yumei;Li Siyi;Liu Hanxiong;Cai Lin(Department of Cardiology,Affiliated Chengdu No.3 People's Hospital of Southwest Jiaotong University Medical School,Chengdu 610031,Sichuan Province,China)

机构地区：[1]西南交通大学医学院成都市第三人民医院心内科,610031

出　　处：《中华老年心脑血管病杂志》2020年第11期1144-1148,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：四川省科技计划项目(2018JY0126)。

摘　　要：目的探讨成都地区老年急性ST段抬高型心肌梗死(STEMI)患者临床特征及治疗现状。方法选择2017年1月~2019年6月就诊于成都地区11家综合医院胸痛中心的老年STEMI患者1017例,根据本研究医院2018年3月通过中国胸痛中心认证分为时间段1组498例(2017.01.01~2018.03.31)和时间段2组519例(2018.04.01~2019.06.30)。分析2组临床特征及治疗现状。结果与时间段1组比较,时间段2组年龄、院外转诊比例明显增加,自行来院、血脂异常和外周动脉疾病比例明显降低(P<0.05,P<0.01)。与时间段1组比较,时间段2组患者到达医院大门至导丝通过时间、首次医疗接触到导丝通过时间明显缩短[74.0(50.0,108.0)min vs 92.5(65.0,132.0)min,P=0.001;110.5(73.0,182.8)min vs 126.5(87.3,179.0)min,P=0.004],出院带药他汀类药物比例明显降低(77.5%vs 80.3%,P=0.010)。多因素logistic回归分析显示,Killip≥Ⅱ级、心率、收缩压、血糖、≥2支血管病变和PCI是院内死亡的独立影响因素(P<0.01)。结论对于成都地区老年STEMI住院患者,再灌注治疗已经成为主要的治疗手段,院外带药亦基本符合指南要求。Objective To study the clinical characteristics and treatment of elderly STEMI patients in Chengdu area.Methods A total of 1017 elderly STEMI patients admitted to 11 general hospitals in Chengdu area from January 2017 to June 2019 were divided into group one(n=498)and group two(n=519).Their clinical characteristics and treatment were analyzed.Results The age was older and the ratio of patients transferred from other hospitals was significantly higher while the ratio of patients who visited hospitals on their own and the incidence of dyslipidemia and peripheral arterial diseases were significantly lower in group two than in group one(P<0.05,P<0.01).The time from hospital visit to balloon dilation and the time from first medical contact to balloon dilation were significantly shorter and the ratio of statins prescribed for dischared patients was significantly lower in group two than in group one[74.0(50.0,108.0)min vs 92.5(65.0,132.0)min,P=0.001;110.5(73.0,182.8)min vs 126.5(87.3,179.0)min,P=0.004;77.5%vs 80.3%,P=0.010].Multivariate logistic regression analysis showed that cardiac function Killip classification≥Ⅱ,heart rate,SBP,blood glucose,≥2 diseased blood vessels and PCI were the independent influencing factors of in-hospital death(P<0.01).Conclusion Reperfusion has become the main therapy for elderly STEMI patients in Chengdu area.The drugs prescribed for discharged patients are basically in line with the guideline requirements.

关 键 词：心肌梗死 胸痛 血脂异常 再灌注 

分 类 号：R542.22[医药卫生—心血管疾病]