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目的探讨急性ST段抬高型心肌梗死(STEMI)合并或不合并高血压患者的临床特征及住院死亡原因。方法入选2007年1月至2010年1月期间入住安徽医科大学第一附属医院心内科的STEMI患者317例,分为有高血压史STEMI组(高血压组,n=166)和无高血压史STEMI组(非高血压组,n=151)。探讨合并高血压的STEMI患者的临床特征及住院死亡可能原因。结果高血压组平均年龄高于非高血压组[(66.3±11.5)比(60.9±14.9)岁,P<0.05]。高血压组心力衰竭和住院死亡发生率高于非高血压组[30.1%比17.1%;12.7%比3.3%;均P<0.05]。多元逐步Logistic回归分析发现入院时心率、心源性休克及节段性运动异常为STEMI患者住院死亡的重要危险因素(均P<0.05)。入院时收缩压及合并心房颤动是STEMI合并高血压患者住院死亡的重要预测因子(均P<0.05)。结论合并高血压的STEMI患者年龄较大,心力衰竭和住院死亡发生率较高。入院时心率、心源性休克及节段性运动异常可能为STEMI患者住院死亡的重要危险因素。
Objective To investigate the clinical characteristics and causes of death in hospital with acute ST-elevation myocardial infarction (STEMI) with or without hypertension. Methods A total of 317 STEMI patients admitted to the First Affiliated Hospital of Anhui Medical University from January 2007 to January 2010 were divided into STEMI group (hypertension group, n = 166) and history of no hypertension STEMI group (non-hypertensive group, n = 151). To investigate the clinical characteristics of STEMI patients with hypertension and possible causes of hospital death. Results The mean age of hypertension group was higher than that of non-hypertension group (66.3 ± 11.5 vs 60.9 ± 14.9 years, P <0.05). The incidence of heart failure and hospital mortality in hypertensive group was higher than that in non-hypertensive group [30.1% vs 17.1%; 12.7% vs 3.3%; both P <0.05]. Multivariate stepwise Logistic regression analysis found that heart rate, cardiogenic shock and segmental motor dysfunction were major risk factors for in-hospital mortality in STEMI patients (all P <0.05). Systolic blood pressure and atrial fibrillation at admission were important predictors of hospital mortality in STEMI patients with hypertension (all P <0.05). Conclusions STEMI patients with hypertension are older, with a higher incidence of heart failure and hospitalization. Heart rate, cardiogenic shock, and segmental motor dysfunction at admission may be an important risk factor for in-hospital mortality in STEMI patients.