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目的 :分析单中心10年来40岁以下急性心肌梗死(acute myocardial infarction,AMI)患者的发病诱因、梗死部位及治疗方式选择等特点。方法:收集并分析1999年1月~2009年1月诊断为AMI的青年(≤40岁)患者的临床资料,收集同期老年(60~75岁)患者进行配对比较。结果:青年组106例,老年组112例。46.23%的青年人无明确的病因,饮酒为其独特的诱因。青年组以前壁受累为主,其次为下壁/后壁;而老年组以下壁/后壁受累为主,其次为前壁。与老年组相比,青年组左室收缩末期内径较小(P<0.01),而左室射血分数无明显差异。青年组单纯溶栓治疗、溶栓治疗+择期支架植入治疗率明显较老年组高(P<0.01)。结论:青年人应注重体检,改善生活方式。青年AMI较多累及前壁,临床治疗虽积极,但与指南推荐仍有较大差距,部分医院应加快绿色通道建立,使更多患者获益。
OBJECTIVE: To analyze the predisposing factors, the infarction location and the choice of treatment modalities for patients with acute myocardial infarction (AMI) under 40 years of age in a single center over the past 10 years. Methods: The clinical data of young patients (≤40 years old) diagnosed with AMI from January 1999 to January 2009 were collected and analyzed. Paired comparisons were collected between the elderly patients aged 60-75 years. Results: There were 106 cases in youth group and 112 cases in elderly group. 46.23% of young people have no definite cause and drinking is their unique incentive. The former group was mainly affected by the anterior wall, followed by the inferior wall / posterior wall; while the latter group was mainly affected by the inferior wall / posterior wall, followed by the anterior wall. Compared with the elderly group, the young group left ventricular end systolic diameter smaller (P <0.01), while no significant difference in left ventricular ejection fraction. Thrombolytic therapy, thrombolytic therapy and elective stent implantation in the youth group were significantly higher than those in the elderly group (P <0.01). Conclusion: Young people should pay attention to physical examination and improve their lifestyle. The AMI in young patients is more involved in the anterior wall. Although clinical treatment is positive, there is still a long way to go before the guidelines are recommended. Some hospitals should speed up the establishment of a green channel to benefit more patients.