急性心肌梗死合并消化道出血患者的臨床特點及預后情況

楊鳴宇

[摘要]目的 探討急性心肌梗死（AMI）合并消化道出血患者的臨床特點及預后情況。方法 選擇我院心內科在2012年4月～2013年4月收治的193例患者作為研究對象，按照疾病類型分為三組，A組為未發生消化道出血的AMI患者，共100例，B組為AMI后發生消化道出血的患者，共52例，C組為消化道出血后發生AMI的患者，共41例。觀察三組患者的生化指標及臨床治療差異，隨訪2年后，比較三組患者再發循環系統功能障礙疾病（包括再發心絞痛、心力衰竭、非致死性AMI等）的情況及死亡率。結果 三組患者的生化指標及臨床治療情況存在較大差異；B、C組患者的腎小球濾過率（EGFR）顯著低于A組，B、C組患者的活化部分凝血活酶時間（APTT）長于A組，B、C組患者的血紅蛋白（Hb）值明顯低于A組，且上述差異均有統計學意義（P<0.05）。三組患者使用阿司匹林及氯吡格雷等抗凝藥物的比例均互不相同，且差異均有統計學意義（P<0.05）；B、C組患者均有消化道出血，B組輸血患者的比例遠遠低于C組，差異有統計學意義（P<0.05）。經過2年的跟蹤隨訪，發現B、C組再發循環系統功能障礙疾病的患者比例和死亡率高于A組，差異有統計學意義（P<0.05）。結論 合并消化道出血的AMI患者的臨床表現比單純的AMI患者更加復雜，抗凝治療更加困難，且再發風險大，預后差。

[關鍵詞]急性心肌梗死；消化道出血；臨床特點；預后情況

[中圖分類號] R542.2+2 [文獻標識碼] A [文章編號] 1674-4721（2017）03（a）-0047-03

[Abstract]Objective To explore the clinical features and prognosis of patients with acute myocardial infarction （AMI） complicated with gastrointestinal bleeding.Methods 193 patients treated in our department of cardiology from April 2012 to April 2014 were selected as research objects.According to the disease types，the patients were divided into three groups：group A （AMI without gastrointestinal bleeding），totally 100 cases，group B（gastrointestinal bleeding following AMI），totally 52 cases，group C（AMI following gastrointestinal bleeding）for after patients，totally 41 cases.The difference of biochemical indexes and clinical tmeament among three groups were observed.After two-years follow-up，the recurrence（including angina pectoris，heart failure，nonfatal AMI，etc.）and mortality of the three groups were compared.Results The biochemical indicators and clinical treatment of patients in three groups differed greatly from each other；glomerular filtration rates of group B and C were significantly lower than that of group A，and activated partial thromboplastin time （APTT） of group B and C was longer than that of group A，and hemoglobin of group B and C was lower than that of group A，and these differences were statistically significant（P<0.05）.The use of anticoagulant drug in three groups such as Aspirin and Clopidogrel were differed from each other，and differences were statistically significant （P<0.05）.Although patients in group B and C both were with gastrointestinal bleeding，patients in group B needed less blood transfusion than that in group C，and difference was statistically significant （P<0.05）.After two-years follow-up，the recurrence of circulatory dysfunction diseases and mortality of group B and C were more than those of group A，and differences were statistically significance （P<0.05）.Conclusion AMI patients complicated with gastrointestinal bleeding have more clinical features，need more complex anticoagulant treatment，suffer more risks of recurrence，and have worse prognosis than AMI patients without gastrointestinal bleeding.