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目的探讨影响急性心肌梗死(AMI)患者住院病死率的因素。方法回顾分析AMI患者2 136例,比较出院时存活和住院期间死亡两组患者的临床特征和住院治疗,并应用Logistic回归分析筛选影响AMI患者住院病死率的因素。结果与存活组相比,死亡组患者年龄较大[(71±10)岁vs(62±11)岁,P<0.01],男性和有吸烟史者较少(56.0%vs71.5%,P<0.01;45.2%vs54.2%,P<0.05),高血压病、糖尿病和高脂血症患病率较高(分别为58.3%vs43.2%,47.7%vs21.1%,72.0%vs58.8%,均P<0.01),心功能Killip分级较高(2.0±1.1vs1.2±0.5,P<0.01),急性期再灌注治疗率和住院期间β受体阻滞剂及硝酸酯类药物的使用率较低(分别为10.1%vs30.3%,47.0%vs71.1%,95.2%vs98.6%,均P<0.01)。Logistic回归分析显示年龄、高血压病、糖尿病、高脂血症、心功能Killip分级、再灌注治疗、β受体阻滞剂和硝酸酯类药物的使用率为影响AMI患者住院病死率的独立危险因素。结论年龄、高血压病、糖尿病、高脂血症、心功能Killip分级、再灌注治疗、β受体阻滞剂和硝酸酯类药物的使用率对AMI患者住院病死率有显著影响。
Objective To investigate the factors influencing in-hospital mortality in patients with acute myocardial infarction (AMI). Methods Two hundred and thirteen patients with AMI were retrospectively analyzed. The clinical characteristics and hospitalization were compared between two groups of patients who survived the hospital discharge and those who died during the hospitalization. Logistic regression analysis was also used to screen the factors influencing in-hospital mortality in AMI patients. Results Compared with the survival group, the death group was older ([71 ± 10] vs (62 ± 11) years, P <0.01], and there were fewer males and those with smoking history (56.0% vs 71.5%, P <0.01; 45.2% vs54.2%, P <0.05). The prevalence of hypertension, diabetes and hyperlipidemia were higher (58.3% vs43.2%, 47.7% vs21.1%, 72.0% vs58 .8%, all P <0.01). The Killip score of heart function was higher (2.0 ± 1.1 vs 1.2 ± 0.5, P <0.01). The rate of acute reperfusion and β-blockers and nitrates Drug use rates were lower (10.1% vs30.3%, 47.0% vs71.1%, 95.2% vs98.6%, respectively, P <0.01). Logistic regression analysis showed that age, hypertension, diabetes, hyperlipidemia, Killip grade, reperfusion therapy, β-blockers and nitrates were independent risk factors for in-hospital mortality in AMI patients factor. Conclusions Age, hypertension, diabetes mellitus, hyperlipidemia, Killip grade, reperfusion therapy, β-blockers and nitrates have a significant effect on in-hospital mortality in patients with AMI.