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目的分析本院11年间2个时段急性心肌梗死死亡患者的临床诊疗方法及死亡原因,为进一步降低急性心肌梗死病死率提供客观临床依据。方法对我院心内科1997-2000年199例急性心肌梗死中32例住院死亡病例(A组)和2005-2008年1 597例急性心肌梗死中99例住院死亡病例(B组)的一般临床资料、药物治疗、心肌再灌注治疗、心功能分级、并发症及死亡原因等进行回顾性比较分析;并比较两组住院病死率。结果两组在性别构成比、平均年龄、危险因素方面比较差异无统计学意义,就诊时间≤12 h者所占比例A组低于B组,再发心肌梗死者所占比例A组高于B组。两组用药情况比较,调脂药A组低于B组,硝酸酯类药物A组高于B组,而β受体阻滞剂、抗凝药、血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂、抗血小板药物的使用差异无统计学意义。经皮冠状动脉介入治疗A组低于B组。并发症、心源性原因所致死亡两组比较差异无统计学意义,而在心外原因所致死亡者A组高于B组。Killip分级I、II级者所占比例A组低于B组;Ⅳ级者所占比例A组高于B组。住院病死率A组明显高于B组。结论近4年急性心肌梗死患者调脂药、冠状动脉介入治疗比例明显增多。住院病死率明显下降。
Objective To analyze the clinical diagnosis and treatment of death in patients with acute myocardial infarction in two stages during 11 years in our hospital and provide objective clinical evidence for further reducing the mortality of acute myocardial infarction. Methods The clinical data of 32 inpatient deaths (A group), 199 cases of acute myocardial infarction (A group) and 99 cases of in-hospital death cases (B group) from 1 597 cases of acute myocardial infarction in our hospital from 1997 to 2000 were analyzed retrospectively. , Drug treatment, myocardial reperfusion therapy, cardiac function classification, complications and causes of death were retrospectively analyzed and compared; and the in-hospital mortality was compared between the two groups. Results There was no significant difference in gender composition ratio, mean age and risk factors in the two groups, the proportion of the patients who were treated less than 12 hours in group A was lower than that in group B, the proportion of patients with recurrent myocardial infarction was higher than that in group B group. The two groups of drug use, lipid-lowering drug group A was lower than the B group, nitrates group A was higher than the B group, and β-blockers, anticoagulants, angiotensin converting enzyme inhibitors / angiotensin Ⅱ receptor antagonist, anti-platelet drug use difference was not statistically significant. Percutaneous coronary intervention in group A was lower than in group B. There was no significant difference between the two groups in the complication and the cause of death due to cardiogenic disease, but the death in the extracardiac group A was higher than that in the B group. The proportion of Killip grade I and II grade in group A was lower than that in group B; the proportion of grade IV in group A was higher than that in group B. In-hospital mortality was significantly higher in group A than in group B. Conclusion In recent 4 years, patients with acute myocardial infarction, lipid-lowering drugs, coronary intervention rate was significantly increased. In-hospital mortality decreased significantly.