本文選題：急性ST段抬高性心肌梗死 + 住院死亡率��； 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：目的:研究STEMI住院患者的入院一般情況、既往病史、輔助檢查、治療情況及并發(fā)癥的情況,分析STEMI患者住院死亡率及相關(guān)因素,為臨床治療提供指導(dǎo)。方法:搜集吉林大學(xué)白求恩第一醫(yī)院心內(nèi)科2014.06.01-2015.12.31住院診斷為STEMI病歷2766例。其中死亡患者132例,存活患者2634例。首先分析總體STEMI患者性別、年齡、再灌注治療情況以及心梗部位與住院死亡率的關(guān)系。其次選取病史資料完整的死亡患者109例作為死亡組,同時(shí)以死亡組患者的年齡(±10歲)、性別、住院時(shí)間(±3月)以及心梗部位來(lái)匹配,并按照1:4的方案隨機(jī)化選擇符合條件的存活患者436例作為存活組,然后分析兩組患者既往病史,生命體征、輔助檢查,治療情況、并發(fā)癥的差異。結(jié)果:1、本研究納入STEMI患者總體住院死亡率4.8%(132/2766)。在年齡方面,老年組住院死亡率高于青年組和中年組。在性別方面,女性住院死亡率高于男性。在治療方面,保守組住院死亡率高于急診PCI組和擇期PCI組。在心梗部位方面,廣泛前壁心梗組住院死亡率高于其他部位心梗組高,下壁、右室、正后壁心梗組住院死亡率和前間壁心梗組低于其他部位心梗組。2、單因素分析死亡組和存活組患者在心率、收縮壓、舒張壓、Killip分級(jí)、心功能EF值、CKMB值、入院隨機(jī)血糖、血肌酐、白細(xì)胞、中性粒細(xì)胞絕對(duì)值、嗜酸性粒細(xì)胞絕對(duì)值、紅細(xì)胞分布寬度、心力衰竭、心源性休克、機(jī)械性并發(fā)癥、心律失常、室速、室顫、三度房室傳導(dǎo)阻滯、完全性右束支傳導(dǎo)阻滯、雙聯(lián)抗血小板藥物、β受體阻滯劑、ACEI/ARB、他汀類調(diào)脂藥、利尿劑的方面差異有統(tǒng)計(jì)學(xué)意義。3、多因素COX回歸分析,結(jié)果顯示:Killip分級(jí)、室顫、完全性右束支傳導(dǎo)阻滯、機(jī)械性并發(fā)癥是STEMI住院死亡的獨(dú)立危險(xiǎn)因素。結(jié)論:1、急診PCI或擇期PCI治療可以顯著降低STEMI患者住院死亡率。2、急性廣泛前壁心肌梗死患者較其余部位心肌梗死組發(fā)生住院死亡的風(fēng)險(xiǎn)高。3、入院Killip分級(jí)、室顫、完全性右束支傳導(dǎo)阻滯、機(jī)械性并發(fā)癥是STEMI患者住院死亡的獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective: to study the general condition, past medical history, adjuvant examination, treatment and complications of STEMI inpatients, to analyze the mortality rate and related factors of STEMI patients, and to provide guidance for clinical treatment. Methods: 2766 cases of STEMI in Department of Cardiology, Bai Qiuen first Hospital, Jilin University were collected from January to December 31, 2014.06.01-2015.12. Among them, 132 died and 2634 survived. First, the sex, age, reperfusion status and the location of myocardial infarction in patients with STEMI were analyzed. 109 patients with complete history were selected as the death group. The age (鹵10 years), sex, length of stay (鹵3 months) and myocardial infarction site of the patients in the death group were matched. According to the 1:4 scheme, 436 patients were randomly selected as survival group. The differences of past medical history, vital signs, adjuvant examination, treatment and complications between the two groups were analyzed. Results: 1, this study included the overall hospital mortality rate of STEMI patients (4.82 / 2766). In terms of age, the inpatient mortality rate in the elderly group was higher than that in the young and middle age group. In terms of gender, female hospital mortality is higher than male. In treatment, the mortality rate of conservative group was higher than that of emergency PCI group and selective PCI group. In terms of myocardial infarction, the mortality rate of patients with extensive anterior myocardial infarction was higher than that of other myocardial infarction groups. The mortality rate in patients with positive posterior myocardial infarction and anterior myocardial infarction group was lower than that in other myocardial infarction groups. Univariate analysis showed that patients in death group and survival group had heart rate, systolic blood pressure, diastolic blood pressure and Killip grade, cardiac function EF value and CK-MB value, admission random blood glucose, serum creatinine. WBC, neutrophil absolute value, eosinophil absolute value, erythrocyte distribution width, heart failure, cardiogenic shock, mechanical complications, arrhythmia, ventricular tachycardia, ventricular fibrillation, three degree atrioventricular block, Complete right bundle branch block, double antiplatelet drugs, 尾 -receptor blocker ACEI / ARB, statins, diuretics were significantly different. Multivariate COX regression analysis showed that: Killip grade, ventricular fibrillation, ventricular fibrillation (VF), ventricular fibrillation (VF). Complete right bundle branch block and mechanical complications were independent risk factors for hospital death in STEMI. Conclusion: emergency PCI or selective PCI therapy can significantly reduce the mortality rate of STEMI patients. The risk of hospital death in patients with acute extensive anterior wall myocardial infarction is higher than that in other myocardial infarction patients. The hospitalization Killip grade and ventricular fibrillation are also found in patients with acute extensive anterior wall myocardial infarction. Complete right bundle branch block and mechanical complications are independent risk factors for hospital death in STEMI patients.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R542.22

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