• 鄭州人民醫(yī)院呼吸科( 河南鄭州 450000) 通訊作者: 王紅軍, E-mail: whjun1919@ 163. com;

目的  探討老年COPD 急性加重期( AECOPD) 患者合并急性心肌梗死的臨床特征, 以減少誤診及漏診。方法  回顧性分析鄭州人民醫(yī)院呼吸科2007 年5 月至2009 年12 月收治的16 例老年AECOPD 合并急性心肌梗死患者的臨床資料, 與同時(shí)期未合并急性心肌梗死的128 例老年AECOPD 患者( 對(duì)照組) 的臨床資料進(jìn)行比較。結(jié)果  兩組患者均無典型心前區(qū)疼痛、意識(shí)障礙及低血壓。與對(duì)照組相比, 急性心肌梗死組患者主要癥狀為胸悶、呼吸困難加重( 16 /16 比4/128, P  lt;0. 01) , 多伴有發(fā)熱( 11 /16 比6/128, P  lt;0. 005) 、食欲減退( 10/16 比23/128, P  lt; 0. 05) ; 胸部X 線檢查斑片狀陰影檢出率增加( 16/16 比62/128, P  lt; 0. 05) ; PaO2 明顯降低[ ( 43. 72 ±3. 64) mmHg比( 82. 26 ±11. 41) mmHg, P  lt; 0. 01] ; 血紅細(xì)胞計(jì)數(shù)偏高[ ( 6. 43 ±0. 42) ×1012 /L 比( 4. 11 ±1. 24) ×1012 /L, P  lt;0. 05) ] , 總膽固醇含量偏高[ ( 6. 51 ±0. 84) mmol /L 比( 3. 93 ±1. 14) mmol /L, P  lt;0. 05) ,
有創(chuàng)機(jī)械通氣需求增加( 13 /16 比11/128, P  lt;0. 05) ; 住院時(shí)間明顯延長[ ( 35 ±13) d 比( 11 ±3) d,P  lt;0. 001) ] , 住院費(fèi)用明顯增加[ ( 3. 20 ±1. 10) 萬元比( 0. 76 ±0. 28) 萬元, P  lt;0. 01) ] , 住院期間死亡率增加( 2/16 比3 /128, P  lt;0. 01) 。結(jié)論  當(dāng)老年AECOPD 患者突然出現(xiàn)胸悶、呼吸困難加重, 應(yīng)警惕急性心肌梗死的發(fā)生。

引用本文： 王紅軍,于洪濤,賈金廣. 16 例老年COPD 急性加重期患者合并急性心肌梗死的臨床分析. 中國呼吸與危重監(jiān)護(hù)雜志, 2010, 9(6): 627-630. doi: 復(fù)制

1. Zhong N,Wang C, Yao W, et al. Prevalence of chronic obstructive pulmonary disease in China: a large, population-based survey. Am J Respir Crit Care Med, 2007 , 176: 753-760 .
2. Finkelstein J, Cha E, Scharf SM. Chronic obstructive pulmonary disease as an independent risk factor for cardiovascular morbidity.Int J Chron Obstruct Pulmon Dis, 2009, 4: 337 -349.
3. 中華醫(yī)學(xué)會(huì)心血管病學(xué)分會(huì), 中華心血管病雜志編輯委員會(huì).不穩(wěn)定性心絞痛和非ST 段抬高心肌梗死診斷和治療指南. 中華心血管病雜志, 2007, 35: 295 -304.
4. Sabit R, Bolton CE, Edwards PH, et al. Arterial stiffness and osteoporosis in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2007, 175: 1259-1265.
5. Selcuk H, Maden O, Selcuk MT, et al. Documentation of impaired coronary blood flow in chronic obstructive pulmonary disease patients. Circ J, 2010 , 74: 346-352.
6. Clayton TC, Thompson M, Meade TW. Recent respiratory infection and risk of cardiovascular disease: case-control study through a general practice database. Eur Heart J, 2008 , 29 : 96-103 .
7. Madjid M, Vela D, Khalili-Tabrizi H, et al. Systimic infections cause exaggerated local inflammation in atherosclerotic coronary arteries:clues to the triggering effect of acute infection on acute coronary syndromes. Tex Heart Inst J, 2007, 34: 11-18.
8. McNicol A, Israsels SJ. Beyond hemostasis: the role of platelets in inflammation malignancy and infection. Cardiovasc Hematol Disord Drug Targets, 2008, 8: 99-117.
9. Stone PH. Triggering myocardial infarction. N Engl J Med, 2004 ,351: 1716-1718.
10. Schouten M, Wiersinga WJ, Levi M, et al. Inflammation,endothelium, and coagulation in sepsis. J Leukoc Biol, 2008, 83 :536-545.
11. Tekin M, G??kaslan S, Diker E, et al. Development of acute coronary syndrome in three patients with essential thrombocythemia or polycythemia vera. Turk Kardiyol Dern Ars, 2008, 36: 35-38 .
12. 陳國榮. 局部血液循環(huán)障礙. 見: 病理學(xué). 李玉林, 主編. 第7 版.北京: 人民衛(wèi)生出版社, 2008, 38 -57 .
13. 何權(quán)瀛, 周新, 謝燦茂, 等. 慢性阻塞性肺疾病對(duì)中國部分城市患者生命質(zhì)量和經(jīng)濟(jì)負(fù)擔(dān)的影響. 中華結(jié)核和呼吸雜志, 2009 ,32: 253-257 .
  1. 1. Zhong N,Wang C, Yao W, et al. Prevalence of chronic obstructive pulmonary disease in China: a large, population-based survey. Am J Respir Crit Care Med, 2007 , 176: 753-760 .
  2. 2. Finkelstein J, Cha E, Scharf SM. Chronic obstructive pulmonary disease as an independent risk factor for cardiovascular morbidity.Int J Chron Obstruct Pulmon Dis, 2009, 4: 337 -349.
  3. 3. 中華醫(yī)學(xué)會(huì)心血管病學(xué)分會(huì), 中華心血管病雜志編輯委員會(huì).不穩(wěn)定性心絞痛和非ST 段抬高心肌梗死診斷和治療指南. 中華心血管病雜志, 2007, 35: 295 -304.
  4. 4. Sabit R, Bolton CE, Edwards PH, et al. Arterial stiffness and osteoporosis in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2007, 175: 1259-1265.
  5. 5. Selcuk H, Maden O, Selcuk MT, et al. Documentation of impaired coronary blood flow in chronic obstructive pulmonary disease patients. Circ J, 2010 , 74: 346-352.
  6. 6. Clayton TC, Thompson M, Meade TW. Recent respiratory infection and risk of cardiovascular disease: case-control study through a general practice database. Eur Heart J, 2008 , 29 : 96-103 .
  7. 7. Madjid M, Vela D, Khalili-Tabrizi H, et al. Systimic infections cause exaggerated local inflammation in atherosclerotic coronary arteries:clues to the triggering effect of acute infection on acute coronary syndromes. Tex Heart Inst J, 2007, 34: 11-18.
  8. 8. McNicol A, Israsels SJ. Beyond hemostasis: the role of platelets in inflammation malignancy and infection. Cardiovasc Hematol Disord Drug Targets, 2008, 8: 99-117.
  9. 9. Stone PH. Triggering myocardial infarction. N Engl J Med, 2004 ,351: 1716-1718.
  10. 10. Schouten M, Wiersinga WJ, Levi M, et al. Inflammation,endothelium, and coagulation in sepsis. J Leukoc Biol, 2008, 83 :536-545.
  11. 11. Tekin M, G??kaslan S, Diker E, et al. Development of acute coronary syndrome in three patients with essential thrombocythemia or polycythemia vera. Turk Kardiyol Dern Ars, 2008, 36: 35-38 .
  12. 12. 陳國榮. 局部血液循環(huán)障礙. 見: 病理學(xué). 李玉林, 主編. 第7 版.北京: 人民衛(wèi)生出版社, 2008, 38 -57 .
  13. 13. 何權(quán)瀛, 周新, 謝燦茂, 等. 慢性阻塞性肺疾病對(duì)中國部分城市患者生命質(zhì)量和經(jīng)濟(jì)負(fù)擔(dān)的影響. 中華結(jié)核和呼吸雜志, 2009 ,32: 253-257 .