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目的探讨女性急性心肌梗死(AMI)患者院内生存情况及危险因素。方法选择AMI患者2667例,其中男性2042例(男性组),女性625例(女性组)。女性组按院内生存情况又分为生存组565例,死亡组60例。分析女性组与男性组一般情况、既往病史、家族史、临床检查、并发症、治疗及生存情况。结果女性组院内病死率明显高于男性组(9.6%vs 5.3%,P<0.01),其中接受PCI患者病死率明显低于未行PCI患者(5.1%vs 25.7%,P<0.01),急诊PCI患者病死率明显高于择期PCI患者(10.1%vs 2.5%,P<0.01)。女性AMI患者院内预后与ST段抬高型心肌梗死、红细胞比容、治疗方法、β受体阻滞剂、他汀类药物呈正相关,与年龄、重度心力衰竭、心源性休克、三度房室传导阻滞、心房颤动、肌钙蛋白T峰值、术后肌酐呈负相关(P<0.05,P<0.01)。女性AMI患者院内死亡的独立危险因素包括年龄、尿素、肌钙蛋白T峰值、主动脉内球囊反搏及他汀类药物(P<0.05,P<0.01)。结论临床需更加关注女性发病情况,重视尿素、肌钙蛋白水平及使用主动脉内球囊反搏、最优化药物治疗等。
Objective To investigate the in-hospital survival and risk factors of female patients with acute myocardial infarction (AMI). Methods 2667 AMI patients were selected, including 2042 males (male) and 625 females (female). Female group according to the survival of the hospital is divided into survival group 565 cases, death group 60 cases. Analysis of the general situation of women and men, past medical history, family history, clinical examination, complications, treatment and survival. Results The case fatality rate in female group was significantly higher than that in male group (9.6% vs 5.3%, P <0.01). The mortality of patients receiving PCI was significantly lower than that of those without PCI (5.1% vs 25.7%, P <0.01) Patient mortality was significantly higher than elective PCI (10.1% vs 2.5%, P <0.01). The prognosis of female patients with AMI was positively correlated with ST segment elevation myocardial infarction, hematocrit, treatment, β-blockers and statins, and with age, severe heart failure, cardiogenic shock, third degree atrioventricular Conduct block, atrial fibrillation, troponin T peak and postoperative creatinine were negatively correlated (P <0.05, P <0.01). Independent risk factors for in-hospital mortality in women with AMI included age, urea, troponin T peak, intra-aortic balloon pump and statins (P <0.05, P <0.01). Conclusion The clinical needs more attention to the incidence of women, attention to urea, troponin levels and the use of aortic balloon pump, the optimal drug treatment.