本文選題：冠狀動脈疾病 + 季節(jié)�。� 參考：《天津醫(yī)科大學(xué)》2013年碩士論文

【摘要】：目的：探討天津市季節(jié)變化和氣象因素對老年急性冠狀動脈綜合征轉(zhuǎn)歸情況的影響,找出對患者病死率較高的季節(jié)、主要?dú)庀笠蛩丶案唢L(fēng)險(xiǎn)人群,制定相應(yīng)的措施來降低老年急性冠狀動脈綜合征患者的病死率,提高好轉(zhuǎn)率。方法：住院且診斷明確的1701例急性冠狀動脈綜合征患者,按入院季節(jié)和氣象因素分組,分析研究對象的性別、年齡、個(gè)人史、既往史、入院時(shí)情況和轉(zhuǎn)歸情況,對死亡患者的年齡分層進(jìn)行亞組分析。結(jié)果：急性冠狀動脈綜合征病死率在春季為15.6%(71/456),夏季為8.5%(26/305),秋季為10.1%(42/417),冬季為16.6%(87/523),其差異有統(tǒng)計(jì)學(xué)意義(P0.01),冬季比夏秋季病死率高(P0.05),春季比夏季病死率高(P0.05)。與夏季相比春冬季死亡的患者年齡較高(P0.05)。既往有高血壓者在冬季比夏秋季的病死率高(P0.05),有冠心病者在秋冬季的病死率比春夏季高(P0.05),ST段有明顯改變的病死率冬季比春季高(P0.05)。急性冠脈綜合征患者的轉(zhuǎn)歸情況在日平均氣溫的分布差異有統(tǒng)計(jì)學(xué)意義(χ2=48.2235,P0.05)。日平均氣溫小于6℃時(shí),急性冠脈綜合征患者的病死率較6-30℃時(shí)高(P0.05)；24小時(shí)溫差大于14℃時(shí)比小于14℃時(shí)有較高的病死率(χ2=4.2718,P=0.0388,P0.05)和較低的好轉(zhuǎn)率(χ2=7.7361,P=0.0054,P0.01)。患者的轉(zhuǎn)歸情況在日平均氣壓的分布差異有統(tǒng)計(jì)學(xué)意義(χ2=58.90563,P0.05)。日平均氣壓小于1000hPa時(shí),患者的病死率比日平均氣壓在1000-1030hPa時(shí)的病死率高(P0.05);24小時(shí)氣壓差大于5hPa時(shí),急性冠脈綜合征患者的病死率較高,好轉(zhuǎn)率較低(P0.05)。急性冠脈綜合征患者的轉(zhuǎn)歸情況在日平均風(fēng)速和日平均相對濕度的分布差異無統(tǒng)計(jì)學(xué)意義。各年齡分層中,老老年患者的死亡人數(shù)最多(54.0%),年輕老年的次之(39.8%),長壽老年的最少(6.1%),但當(dāng)日平均氣溫大于30℃和日平均氣壓小于1000hPa時(shí),年輕老年的死亡人數(shù)較多(P0.05)。二元logistic回歸分析顯示季節(jié)(OR=1.169,P=0.044,OR值95%CI=1.00～1.360)、冠心病病史(OR=1.536, P=0.033, OR值95%CI=1.036～2.279)、年齡(OR=1.050, P=0.000, OR值95%CI=1.022-1.078)、ST段明顯改變(OR=1.533,P0.05,OR值95%CI=1.070-2.195)、24小時(shí)溫差(OR=4.038,P=0.037,OR值95%CI＝1.089-8.41)、24小時(shí)氣壓差(OR=2.057,P=0.036,OR值95%CI=1.051-4.031)為急性冠狀動脈綜合征病死率的危險(xiǎn)因素。結(jié)論：四季中患者的急性冠脈綜合征患者的轉(zhuǎn)歸情況不同,病死率有高有低,春冬季的病死率較高,患者年齡越高,死亡風(fēng)險(xiǎn)越大,以春冬季為著。各氣象因素會影響急性冠脈綜合征患者的轉(zhuǎn)歸情況,日平均氣溫較低時(shí)、24小時(shí)溫差較大時(shí)、日平均氣壓較低時(shí)和24小時(shí)氣壓差較大時(shí),急性冠脈綜合征患者的病死率較高,好轉(zhuǎn)率較低。年輕老年較老老年和長壽老年的轉(zhuǎn)歸情況更易受高溫和低氣壓的影響,并且有較多的死亡例數(shù)。季節(jié)變化、年齡、冠心病史、ST明顯改變、24小時(shí)溫差及氣壓差為急性冠脈綜合征患者死亡的獨(dú)立危險(xiǎn)因素。合并有冠心病、高血壓、ST段改變明顯的急性冠脈綜合征患者在季節(jié)和氣象因素的變化中為高風(fēng)險(xiǎn)死亡人群。
[Abstract]:Objective: To explore the effects of seasonal and meteorological factors on the prognosis of elderly patients with acute coronary syndromes in Tianjin, and to find out the seasons with high mortality rate, main meteorological factors and high risk population, and formulate corresponding measures to reduce the mortality of the elderly patients with acute coronary syndromes and improve the rate of improvement. In 1701 patients with acute coronary syndrome, the sex, age, personal history, past history, hospitalization and prognosis were analyzed, and the age stratification of the patients was analyzed. Results: the mortality rate of acute coronary syndromes was 15.6% (71/45 6) in summer, 8.5% (26/305), 10.1% (42/417) in autumn and 16.6% (87/523) in winter (P0.01), higher in winter than in summer and autumn (P0.05), higher in spring than in summer (P0.05). The mortality of those who died in spring and winter compared with summer was higher (P0.05). The fatality rate of those with past hypertension was higher in winter than in summer and autumn (P0.). 05), the mortality of patients with coronary heart disease in autumn and winter was higher than that in spring and summer (P0.05), and the mortality of ST segment was significantly higher in winter than in spring (P0.05). The distribution of patients with acute coronary syndrome was statistically significant (x 2=48.2235, P0.05). The average daily temperature was less than 6 C, the disease of patients with acute coronary syndrome was ill. The mortality rate was higher than that of 6-30 C (P0.05); higher mortality rate (x 2=4.2718, P=0.0388, P0.05) and lower improvement rate (x 2=7.7361, P=0.0054, P0.01) were higher when the temperature difference of 24 hours was greater than 14 C and lower (x 2=7.7361, P=0.0054, P0.01). The distribution difference of daily mean pressure in the patient was of general significance (x 2=58.90563, P0.05). The daily mean pressure was less than 1000hPa, The fatality rate of the patients was higher than that of the daily mean pressure of 1000-1030hPa (P0.05); when the 24 hour pressure difference was greater than 5hPa, the mortality of the patients with acute coronary syndrome was higher and the rate of improvement was lower (P0.05). There was no significant difference in the distribution of the average daily wind speed and the daily average relative humidity in the patients with acute coronary syndrome. In the age stratification, the number of dead elderly patients was the most (54%), the next (39.8%) and the least (6.1%) for the elderly, but the average air temperature was greater than 30 and the daily average pressure was less than 1000hPa, and the number of young people died more (P0.05). Two yuan logistic regression analysis showed that the season (OR=1.169, P=0.044, OR value 95%CI=1.00 ~) 1.360), the history of coronary heart disease (OR=1.536, P=0.033, OR value 95%CI=1.036 ~ 2.279), age (OR=1.050, P=0.000, OR value 95%CI=1.022-1.078), ST segment obviously changed (OR=1.533, P0.05, OR value), 24 hour temperature difference, 24 hour pressure difference is acute Conclusions: the risk factors of the mortality of coronary syndrome. Conclusion: the prognosis of patients with acute coronary syndrome in the four seasons is different, the mortality rate is high, the mortality rate is higher in spring and winter, the higher the patient's age, the greater the risk of death, in spring and winter, the weather factors will affect the prognosis of the patients with acute coronary syndrome. When the average temperature is low, when the temperature difference between 24 hours is larger, the average daily pressure is lower and the 24 hour pressure difference is larger, the mortality rate of the patients with acute coronary syndrome is higher and the improvement rate is lower. The prognosis of the younger elderly and the elderly is more susceptible to the influence of high temperature and low pressure, and there are more deaths and seasons. Age, history of coronary heart disease, ST changes, 24 hour temperature difference and pressure difference are independent risk factors for the death of patients with acute coronary syndrome. Patients with coronary heart disease, hypertension, and ST segment changes in acute coronary syndromes have high risk of death in seasonal and meteorological factors.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R543.3;R122.26

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相關(guān)期刊論文 前1條

1 李雄,董蕙青,郭琳芳,字春霞;南寧醫(yī)療氣象預(yù)報(bào)系統(tǒng)[J];廣西氣象;2005年01期

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本文編號：1856349