老年急性心肌梗塞合并多器官功能衰竭临床分析.docVIP

【摘要】 　　目的：探讨老年急性心肌梗塞(AMI)合并老年多器官功能衰竭(MOFE)的临床特点、治疗及转归。方法：回顾分析解放军总医院2004年1月至2006年12月所有238例老年AMI患者中的20例老年AMI合并MOFE患者的资料，分析这些患者的临床特点、治疗及转归。结果：老年广泛前壁AMI患者死亡率为80％；合并心源性休克的MOFE患者死亡率为60％；在老年AMI合并MOFE患者中以肺感染为诱因的占85％；老年AMI患者如合并脑血管基础性疾病，则死亡率为83.3％；在衰竭器官中，以心、肺、肾最为多见，分别占100％、80％、60％；早期介入治疗较溶栓治疗对患者的存活意义更大。结论：老年人AMI合并MOFE时心肌梗塞部位、是否合并心源性休克、脑血管基础疾病对患者预后影响非常大，心脏衰竭可能是老年AMI合并MOFE的始动因素，积极预防肺感染的发生、对合适病人早期实施介入治疗可能会逆转某些老年AMI患者发生MOFE的过程，或者提高救治成功率。 【关键词】 心肌梗塞　老年人　多器官功能衰竭 　　Clinical features of aged patients with acute myocardial infarction complicated multiple organ failure/ GAO Lei,WANG Shi|wen, ZHAO Yu|sheng, LU Cai|yi// 　　Abstract：Objective:To analyze the clinical features，treatment and prognosis of aged patients with acute myocardial infarction(AMI) complicated multiple organ failure(MOFE).Methods:From 2004 to 2006,clinical data of 20 aged AMI cases with MOFE were collected and analyzed.Results:The mortality for patients of acute transmural anterior wall infarction with MOFE was 80％.The mortality for patients with cardiogenic shock and MOFE was 60％.In the 85% aged AMI patients with MOFE，the predisposing cause was pulmonary infection.The mortality of aged AMI patients with cerebrovascular disease was 83.3%.Among all the failure organs,heart,lung and kidney were the most common organs.Early percutaneous coronary intervention had more beneficial effects than thrombolytic therapy.Conclusion:Localization of AMI,cardiogenic shock and cerebrovascular disease have great influence on the prognosis of aged AMI patients with MOFE.Heart perhaps is the first failure organ in aged AMI patients with MOFE.Prevention of pulmonary infection and early revascularization therapy may play key roles in the therapy of aged AMI patients with MOFE. 　　 　　Author′s　address：The Institute of Geriatric Cardiology, Chinese People’s Liberation Army General Hospital，Beijing，100853，China 　　Key words：Myocardial infarction；The aged;Multiple organ failure 　　老年急性心肌梗塞（AMI）合并多器官功能衰竭(MOFE)是指老年人在原有慢性疾病基础上发生AMI后，同时或相继出现