急性心肌梗死患者院内事件和两年随访结果分析

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目的:分析急性ST段(STEMI)与非ST段抬高型心肌梗死(NSTEMI)患者住院情况和2年随访情况,为改善急性心肌梗死患者预后提供参考。方法:选择诊断为STEMI或NSTEMI的患者923例为研究对象,根据诊断和患者接受再灌注的情况分为STEMI药物治疗组(n=56)、STEMI急诊经皮冠状动脉介入(PCI)组(n=368)、NSTEMI药物治疗组(n=61)和NSTEMI-PCI组(n=438)。采用Logistic回归模型分析所有患者院内事件和主要不良心脏事件的独立危险因素和保护因素。结果:STEMI和NSTEMI患者中,选择药物治疗的患者年龄均明显高于选择急诊PCI治疗的患者(P<0.05);STEMI急诊PCI组的患者多由120急救系统护送;STEMI药物治疗组发病到就诊时间明显长于STEMI急诊PCI组(P<0.05);参加医保的STEMI和NSTEMI患者更愿意接受PCI治疗(均P<0.05)。经Logistics回归分析发现,药物保守治疗(P=0.015,OR=1.283,95%CI 1.001~2.656)、Killip分级(P=0.004,OR=2.739,95%CI 1.449~13.504)和发病到就诊时间(P=0.008,OR=2.050,95%CI 1.135~10.437)是院内事件发生的独立危险因素,呼叫120系统是院内事件的保护因素(P=0.021,OR=0.806,95%CI 0.194~0.992)。药物保守治疗(P=0.009,OR=1.673,95%CI1.165~9.659)和Killip分级(P=0.010,OR=1.392,95%CI 1.098~6.473)是主要不良心脏事件的独立危险因素。结论:STEMI或NSTEMI患者发病到就诊时间、年龄和医疗保险等情况会直接影响再灌注治疗方案的选择,再灌注方案直接影响患者的近期和远期预后,而120系统是保障心肌梗死患者转运的有利条件。 Objective: To analyze the hospitalization and 2-year follow-up of patients with acute ST-segment elevation (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) and provide a reference for improving the prognosis of patients with acute myocardial infarction. METHODS: A total of 923 patients with STEMI or NSTEMI were enrolled in this study. Patients were divided into STEMI group (n = 56) and STEMI group (n = 56) according to diagnosis and patient’s reperfusion. = 368), NSTEMI medication group (n = 61) and NSTEMI-PCI group (n = 438). Logistic regression models were used to analyze independent risk factors and protective factors for nosocomial events and major adverse cardiac events in all patients. Results: Patients in the STEMI and NSTEMI groups were significantly older than those in the PCI group (P <0.05). Patients in the STEMI emergency PCI group were more likely to be escorted by the 120 emergency system. Patients in the STEMI group were on treatment The time was significantly longer than the STEMI emergency PCI group (P <0.05). The STEMI and NSTEMI patients were more likely to receive PCI (all P <0.05). Logistic regression analysis showed that conservative treatment (P = 0.015, OR = 1.283, 95% CI 1.001-2.656), Killip classification (P = 0.004, OR = 2.739, 95% CI 1.449-13.54) P = 0.008, OR = 2.050, 95% CI 1.135 to 10.437) were independent risk factors for nosocomial events. Call 120 system was a protective factor for nosocomial events (P = 0.021, OR = 0.806, 95% CI 0.194-0.992). Conservative treatment (P = 0.009, OR = 1.673, 95% CI, from 1.65 to 9.659) and Killip classification (P = 0.010, OR = 1.392, 95% CI 1.098 to 6.473) were independent risk factors for major adverse cardiac events. CONCLUSION: The incidence of STEMI or NSTEMI from onset to treatment, age and medical insurance will directly affect the choice of reperfusion regimen. The reperfusion regimen will directly affect the short-term and long-term prognosis of patients. However, the 120 system is to protect patients with myocardial infarction Favorable conditions
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