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目的评价老年急性ST段抬高心肌梗死不同再灌注治疗的临床治疗现状及疗效。方法回顾性分析2001年3月至2003年6月国内12个心脏中心随机入组的236例年龄≥60岁的急性ST段抬高心肌梗死(STE-MI)患者住院期间的临床资料,比较再灌注治疗和非再灌注治疗组的临床疗效及转归。结果(1)有接近32%的患者未接受任何形式的再灌注治疗;(2)接受再灌注治疗组患者于发病12h内就诊比例明显高于未接受再灌注治疗组(67.8%对32.2%);(3)糖尿病病史是未能接受再灌注治疗的预测因素(OR值为3.216,95%可信区间为2.127~6.432);(4)再灌注治疗组住院期间再发心绞痛、充血性心力衰竭者明显低于未接受再灌注治疗组(P<0.05);(5)接受再灌注治疗组患者的病死率明显降低(5.6%对21.7%)。结论再灌注治疗可以降低年龄≥60岁的急性STEAMI患者的住院病死率,减少住院期间不良心血管事件的发生,且不增加该组患者住院期间的并发症。
Objective To evaluate the clinical effect and therapeutic effect of different reperfusion therapy on senile acute ST elevation myocardial infarction. Methods The clinical data of 236 patients with ST-segment elevation myocardial infarction (STE-MI) aged 60 years and above who were randomly enrolled in 12 heart centers from March 2001 to June 2003 in our hospital were retrospectively analyzed. Clinical efficacy and outcome of perfusion and non-reperfusion groups. Results (1) Nearly 32% of patients did not receive any form of reperfusion therapy; (2) The proportion of patients receiving reperfusion therapy within 12 hours of onset was significantly higher than that of patients without reperfusion (67.8% vs 32.2%) ; (3) Diabetes mellitus history was the predictor of failure to receive reperfusion therapy (odds ratio, 3.216, 95% confidence interval, 2.127-6.432); (4) reperfusion angina pectoris, congestive heart failure (P <0.05). (5) The mortality rate of patients receiving reperfusion therapy was significantly lower (5.6% vs 21.7%) than those without reperfusion therapy. Conclusion Reperfusion therapy can reduce the in-hospital mortality rate of acute STEAMI patients aged> 60 years and reduce the occurrence of adverse cardiovascular events during hospitalization without increasing the complications during hospitalization.