Herzzentrum Ludwigshafen, Bremserstrasse 79, Ludwigshafen, Germany.
Clin Res Cardiol. 2011 Mar;100(3):235-9. doi: 10.1007/s00392-010-0235-6. Epub 2010 Sep 29.
Information about the clinical course of patients with acute myocardial infarction requiring mechanical ventilation is scarce. We sought to evaluate the clinical outcome of a large cohort of such patients in clinical practice.
The German BEAT registry prospectively enrolled consecutive patients requiring mechanical ventilation who were admitted to an internal intensive care unit (ICU) of 45 participating German hospitals between September 2001 and June 2002. For this analysis, we created a subgroup of patients with acute ST-segment-elevation or non-ST-segment-elevation myocardial infarction.
During the 9-month study period, 458 consecutive patients fulfilled our inclusion criteria. The mean age was 68 ± 8 years and 71% were men. 40% of the patients were already intubated in the prehospital phase. The initial reason for intubation was in 48% of the cases ventricular fibrillation/tachycardia or sudden cardiac death, in 39% congestive heart failure and in 13% of the cases non-cardiac. The median time of ventilation was 2 days (1-5) among survivors and 1 day (0-5) among non-survivors. Of the 458 patients, 256 (56%) had already or developed cardiogenic shock, 86 (19%) acute renal failure, 76 (17%) coma or brain damage, 64 (14%) severe infection, 46 (10%) sepsis and 28 (6%) multiorgan distress syndrome; 11% were treated with fibrinolysis, 39% with PCI and 6% with coronary artery bypass grafting. The overall hospital mortality rate was 48%. In patients with cardiogenic shock, mortality was even higher with 69%.
Patients requiring mechanical ventilation during an acute myocardial infarction constitute a high risk group with a mortality of about 50%. Further research is necessary to improve the outcome of these patients.
关于需要机械通气的急性心肌梗死患者的临床病程信息很少。我们试图评估此类患者在临床实践中的大量队列的临床结果。
德国 BEAT 登记前瞻性纳入了 2001 年 9 月至 2002 年 6 月期间在 45 家参与的德国医院的内部重症监护病房（ICU）住院的需要机械通气的连续患者。为此分析，我们创建了一个急性 ST 段抬高或非 ST 段抬高心肌梗死患者亚组。
在 9 个月的研究期间，458 例连续患者符合纳入标准。平均年龄为 68 ± 8 岁，71%为男性。40%的患者在院前阶段已插管。插管的初始原因在 48%的情况下是室颤/心动过速或心源性猝死，在 39%的情况下是充血性心力衰竭，在 13%的情况下是非心源性的。幸存者的通气中位数为 2 天（1-5），非幸存者为 1 天（0-5）。在 458 例患者中，256 例（56%）已经或发生心源性休克，86 例（19%）急性肾功能衰竭，76 例（17%）昏迷或脑损伤，64 例（14%）严重感染，46 例（10%）败血症和 28 例（6%）多器官功能障碍综合征；11%接受纤溶治疗，39%接受 PCI，6%接受冠状动脉旁路移植术。总住院死亡率为 48%。在心源性休克患者中，死亡率甚至更高，为 69%。
急性心肌梗死后需要机械通气的患者构成了一个高风险群体，死亡率约为 50%。需要进一步研究以改善这些患者的预后。
