| 消化道出血诱发急性心肌梗死的临床分析 |
| 投稿时间：2017-07-13 修订日期：2017-09-07 点此下载全文 |
| 引用本文：朱龑,周中银,杨艳.消化道出血诱发急性心肌梗死的临床分析[J].医学研究杂志,2018,47(5):39-42,38 |
| DOI：
10.11969/j.issn.1673-548X.2018.05.010 |
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| 基金项目:湖北省自然科学基金资助项目（2011CHB025）；湖北省科技厅基金资助项目（2013BKB013） |
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| 中文摘要:目的 分析消化道出血诱发急性心肌梗死的临床特点及死亡相关危险因素，提高医务人员对此类此病的诊治水平。方法 回顾性分析2015年1月~2017年1月于武汉大学人民医院就诊的消化道出血诱发急性心肌梗死的28例患者的一般资料、临床表现、实验室检查、心电图变化、治疗及预后情况等，按照患者预后情况，分为生存组（13例）和死亡组（15例），分析影响患者预后的相关因素。结果 28例消化道出血诱发急性心肌梗死患者中，其中男性24例，女性4例，患者平均年龄70.8±11.0岁；有5例表现呕血，有8例表现黑便；有13例表现同时表现呕血与黑便，有2例表现为呕吐咖啡样胃内容物；诱发急性心肌梗死时，仅有6例表现为典型胸痛，有4例表现为心慌、胸闷，有18例无明显症状；所有患者中，急性非ST段抬高型心肌梗死21例（75.0%），急性ST段抬高型心肌梗死7例（25.0%），其中广泛前壁合并下壁梗死2例（7.1%），广泛前壁梗死7例（25.0%），下壁梗死13例（46.4%），前壁梗死5例（17.9%），后壁梗死1例（3.6%）；经治疗，有13例好转，15例死亡。重度贫血及肝硬化病史在生存组及死亡组两组患者中的差异有统计学意义，Logistics回归分析发现重度贫血（OR=11.67，P=0.018）是患者死亡的独立危险因素。结论 消化道出血诱发急性心肌梗死时多无胸痛等典型心肌梗死症状，且多表现为非ST段抬高型心肌梗死，此类患者病情危重，病死率高，重度贫血是此类患者死亡的独立危险因素。 |
| 中文关键词:消化道出血 急性心肌梗死 临床特征 危险因素 |
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| Clinical Analysis of Acute Myocardial Infarction Induced by Gastrointestinal Hemorrhage |
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| Abstract:Objective To analyze the clinical characteristics and risk factors of mortality of acute myocardial infarction induced by gastrointestinal hemorrhage, and improve the diagnosis and treatment of this kind of disease.Methods The clinical data of 28 patients who admitted to renmin hospital of wuhan university between January 2015 and January 2017 was analyzed retrospectively, including general information, clinical features, laboratory examination,the changes of electrocardiogram, the treatment and prognosis of the disease. According to the prognosis, the patients were divided into survival group (13 cases) and death group (15 cases), and the related factors affecting the prognosis were analyzed.Results Among the 28 patients with acute myocardial infarction complicated by gastrointestinal hemorrhage(male 24, female 4), the mean age was (70.8±11.0) years. The clinical symptoms of gastrointestinal hemorrhage included haematemesis in 5 cases, melena in 8 cases, haematemesis concomitant melena in 13 cases and vomiting of coffee-like substance in 2 cases. When acute myocardial infarction occurred, only 6 patients had typical chest pain, 4 patients showed palpitation and chest distress and 18 patients had no obvious symptoms. In all patients, 21 (75.0%) patients occurred non ST-elevation acute myocardial infarction, and 7 (25.0%) patients occurred ST-elevation acute myocardial infarction, including extensive anterior wall and inferior wall infarction in 2 cases (7.1%), extensive anterior wall infarction in 7 cases (25.0%), inferior infarction in 13 cases (46.4%), anterior wall infarction in 5 cases (17.9%) and posterior wall infarction in 1 cases (3.6%). After treatment, 13 cases improved and 15 cases died. Severe anemia and liver cirrhosis had history statistically significant differences in the survival group and death group, logistics regression analysis showed that severe anemia (OR=11.67, P=0.018) was an independent risk factor of mortality.Conclusion Acute myocardial infarction induced by gastrointestinal hemorrhage has no chest pain and other typical symptoms of myocardial infarction, and most of the cases are non ST-elevation myocardial infarction. Such patients are critically ill and have high fatality rate. Severe anemia is an independent risk factor for death in such patients. |
| keywords:Gastrointestinal hemorrhage Acute myocardial infarction Clinical characteristics Risk factor |
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