急性心肌梗死并发多器官功能不全综合征老年患者危险因素探讨

摘要

目的 探讨影响急性心肌梗死(AMI)老年患者并发多器官功能不全综合征(MODS)的危险因素.方法 回顾性分析2003年5月至2008年4月我院收治的260例AMI患者的临床资料,比较普通AMI组(207例)和并发MODS组(53例)的救治措施,并将组间差异有统计学意义的措施进行多因素logistic回归分析.结果 并发MODS发生率为20.4%(53/260).2组临床特征无显著差异.普通AMI组治疗措施包括心电监护201例(97.1%)、严格无菌操作技术202例(97.6%)、心理治疗177例(85.5%)、双联抗血小板197例(95.2%)、抗凝172例(83.1%)、经皮冠脉介入治疗术(PCI)166例(80.2%)及使用机械通气21例(10.1%).而并发MODS组患者采用以上措施的分别为48例(90.6%)、47例(88.7%)、39例(73.6%)、46例(86.8%)、37例(69.8%)、32例(60.4%)及20例(37.7%).2组比较差异有显著性意义(P＜0.05).而β受体阻滞剂、血糖控制、ACEI/ARB在2组比较差异无显著性意义(P＞0.05).进一步多因素回归分析提示心电监护、PCI、机械通气为AMI进展为MODS的3个主要危险因素(OR=0.254、0.447、6.515,P＜0.05).结论 AMI进展为MODS病死率高,心电监护、严格无菌操作技术、心理治疗、双联抗血小板、抗凝及PCI及减少使用机械通气等治疗策略可明显减少AMI进展为MODS.机械通气为AMI进展为MODS的独立危险因素,而心电监护、PCI为其保护因素.%Objective To explore the risk factors in elderly patients with multiple organs dysfunction syndrom (MODS) following acute myocardial infarction. Methods The clinical data of 260 acute myocardial infarction patients admitted from May 2003 to April 2008 were retrospectively analyzed based on the prognosis. Therapeutic strategies were compared between acute myocardial infarction group ( n = 207 ) and acute myocardial infarction complicated with MODS group( n = 53 ). Risk factors affecting MODS following acute myocardial infarction in terms of treatment were analyzed using logistic analysis. Results The incidence of MODS following acute myocardial infarction was 20. 4％. No significant difference between two groups in the clinical feature was found. Therapeutic strategies adopted in the acute myocardial infarction group included electrocardiogram monitoring( 97. 1％, 201/207 ), sterile operative technique (97.6％ ,202/207 ),psychotherapy ( 85.5 ％, 177/207 ), anti-platelet combining with two drugs ( 95.2％, 197/207 ), anticoagulation ( 83. 1 ％,172/207 ), percutaneous coronary interventions ( 80. 2％, 166/207 ) and mechanical ventilation ( 10. 1％, 2 1/207 ). And the rates of these therapeutic strategies adopted in the acute myocardial infarction complicated with MODS group were 90. 6％ (48/53), 88. 7％ (47/53), 73.6％ ( 39/53 ) , 86. 8％ ( 46/53 ) , 69. 8％ ( 37/53 ) 、60. 4％ ( 32/53 ) and 37. 7％(20/53) respectively. These application rates of these therapeutic atrategies in the acute myocardial infarction group were significantly higher than those in the acute myocardial infarction complicated with MODS group ( P ＜ 0. 05 ). However,there was no significant difference in β adrenergic blocking agent, the use of ACEI/ARB and intensive insulin therapy between two groups. And the main risk factors were electrocardiogram monitoring, percutaneous coronary interventions and mechanical ventilation ( OR :0. 254, 0. 447 and 6. 515 respectively, all P ＜0. 05 ). Conclusions The mortality of acute myocardial infarction patients complicated with MODS is high. Electrocardiogram monitoring, sterile operative technique,psychotherapy, anti-platelet combining with two drugs, anticoagulation, pereutaneous coronary interventions and mechanical ventilation can reduce the incidence of acute myocardial infarction patients complicated with MODS.