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目的:探讨影响急性心肌梗死(AMI)后合并多器官功能衰竭(MODS)的老年患者预后相关因素。方法:回顾性分析84例AMI合并MODS患者病死率,根据患者预后分为存活组及死亡组,同时对预后相关情况、合并器官衰竭、治疗策略等30个因素进行组间比较,并将组间差别有统计学意义的因素进行多因素logistic回归分析。结果:患者病死率为56.0%。是否合并大面积前壁心肌梗死、是否合并陈旧性心肌梗死、是否合并肺部感染、是否出现心源性休克、是否使用IABP、Killip分级、是否使用机械通气及需要监护的时间等8个因素死亡组与存活组组间差异有统计学意义(均P<0.05)。进一步多因素回归分析提示心源性休克、大面积前壁心肌梗死、肺部感染为AMI合并MODS的3个主要危险因素,OR分别为14.39、12.11及9.20。其中大面积前壁心肌梗死与心源性休克呈显著正相关(r=0.841,P<0.01)。结论:急性心肌梗死合并多器官功能衰竭病死率高,尤其是出现大面积前壁心肌梗死、心源性休克等严重影响血流动力学及出现肺部感染等情况时,患者预后不良。如何防治血流动力学的急剧改变及肺部感染是改善老年AMI合并MODS患者预后的关键。
Objective: To investigate the prognostic factors of elderly patients with acute organ failure (AMI) complicated with multiple organ dysfunction (MODS). Methods: A total of 84 AMI patients with MODS were enrolled in this study. The mortality was divided into survival group and death group according to the prognosis of patients. At the same time, 30 factors such as prognosis, organ failure and treatment strategy were compared between groups. The differences were statistically significant factors multivariate logistic regression analysis. Results: The case fatality rate was 56.0%. 8 factors such as large area anterior myocardial infarction complicated with old myocardial infarction, pulmonary infection complicated with or without pulmonary heart disease, cardiogenic shock, whether using IABP, Killip grading, whether to use mechanical ventilation and the time required to be monitored The difference between the two groups was statistically significant (all P <0.05). Further multivariate regression analysis showed that cardiogenic shock, large anterior myocardial infarction and pulmonary infection were the three major risk factors for AMI combined with MODS, OR were 14.39,12.11 and 9.20 respectively. A large area of anterior myocardial infarction was significantly associated with cardiogenic shock (r = 0.841, P <0.01). Conclusion: The mortality rate of acute myocardial infarction complicated with multiple organ failure is high, especially in the case of large anterior myocardial infarction, cardiogenic shock and other serious impact on hemodynamics and pulmonary infection, the patient’s prognosis is poor. How to prevent and treat acute changes of hemodynamics and pulmonary infection is the key to improve the prognosis of elderly patients with AMI and MODS.