老年急性心肌梗死患者合并消化道出血的临床特征及预后分析

摘要

Objective To investigate the clinical features, diagnosis, treatment and prognosis of the elderly acute myocardial infarction ( AMI) patients complicated with gastrointestinal bleeding ( GIB) .Methods All 90 patients diagnosed with AMI in our department from January 2012 to April 2014 were recruited in this study.They were divided into AMI group (n=30, without GIB), AMI-GIB group (n=30, GIB occurred after AMI) and GIB-AMI group (n=30, GIB followed by AMI).The clinical features and mortality after 6 months’ follow-up were analyzed.Results The ratio of the patients with a history of gastrointestinal diseases were significantly higher in the AMI-GIB and GIB-AMI groups than in the AMI group (P<0.05), and there were more patients undergoing percutaneous coronary intervention (PCI) in the AMI-GIB group than in the other 2 groups (P<0.05).Activated partial thromboplastin time ( APTT) was obviously longer, and the more patients received blood transfusion and proton pump inhibitors ( PPIs) treatment, while that of those receiving aspirin was less in the AMI-GIB and GIB-AMI groups than in the AMI group ( P<0.05 ) .The level of D-dimer and the ratio of blood urea nitrogen ( BUN)/serum creatinine ( SCr) were much higher in AMI-GIB group than in the other 2 groups (P<0.05).The level of hemoglobin (Hb) and the efficacy of anti-platelet therapy were significantly lower in the GIB-AMI group than in the other 2 groups ( P<0.05) .The mortality was significantly higher in the AMI-GIB group than in the other 2 groups (P<0.05).Conclusion The occurrence of AMI complicated with GIB is closely associated with the histories of gastrointestinal ulcers and PCI procedure.The ratio of BUN/SCr and level of D-dimer might be the predictive indicators for prognosis of GIB after AMI.%目的：研究老年急性心肌梗死（ AMI ）患者合并消化道出血（ GIB ）的临床特点、诊治方法及预后。方法入选2012年1月至2014年4月期间在解放军总医院心内科住院并确诊为AMI的老年患者90例，根据是否合并GIB分为3组：AMI组（n＝30）、AMI后GIB组（AMI-GIB；n＝30）和GIB后AMI组（GIB-AMI；n＝30）。比较各组患者的临床资料，并随访6个月，观察死亡率。结果 AMI-GIB组和GIB-AMI组具有消化道疾病史者显著高于AMI组；AMI-GIB组具有经皮冠状动脉介入治疗（PCI）手术史者显著高于其他两组，差异均具有统计学意义（P＜0．05）。与AMI组相比，其他两组患者的活化部分促凝血酶原激酶时间（ APTT）均显著延长、输血率和质子泵抑制剂（ PPI）使用比例显著增高、阿司匹林的使用率显著降低，差异均具有统计学意义（ P＜0．05）。 AMI-GIB组患者的血浆尿素氮／肌酐（ BUN／SCr）和D－二聚体值均显著高于其他两组（P＜0．05）。 GIB-AMI组患者的血红蛋白（Hb）水平和抗血小板治疗显著低于其他两组（P＜0．05）。随访6个月，AMI-GIB组的死亡率显著高于其他两组，差异具有统计学意义（ P＜0．05）。结论 AMI合并GIB的发生与患者的消化道溃疡病史、PCI手术史密切相关。 BUN／SCr和D－二聚体水平增高可能是AMI后GIB预后判断的监测指标。