Bhatti N, Amoateng-Adjepong Y, Qamar A, Manthous C A
Pulmonary and Critical Care Division, Bridgeport Hospital and Yale University School of Medicine, Conn 06610, USA.
Chest. 1998 Oct;114(4):1137-42. doi: 10.1378/chest.114.4.1137.
To determine the frequency of and risk factors for myocardial infarction (MI) in patients admitted to an ICU with GI hemorrhage, and the effects of MI on mortality and length of stay.
A retrospective review of the medical records of patients admitted to our ICU with GI hemorrhage was conducted. Charts were reviewed for various demographic, laboratory, and outcome parameters. Patients were categorized as having MI, not having MI, or inadequate data to allow classification.
Two hundred thirty admissions to the ICU for GI hemorrhage were reviewed. One hundred thirteen cases had serial creatine phosphokinase (CK) measurements with isoenzymes allowing diagnosis of MI. In these 113 cases, patients' mean age was 67.4+/-1.3 years and the mean APACHE II (acute physiology and chronic health evaluation) score was 10.9+/-0.6. The in-hospital mortality rate was 13/113 (11.5%). Patients who did not survive had a higher admission APACHE II score (15.8+/-2.0 vs 10.2+/-0.5; p = 0.02), lower initial systolic BP (104.5+/-4.4 vs 121.2+/-3.2 mm Hg; p = 0.005), and a longer length of ICU stay (8.3+/-1.8 vs 4.0+/-0.4 days; p = 0.04) than those who survived. Sixteen of 113 patients met enzymatic and ECG criteria for MI. One patient complained of chest pain and nine of 16 had shortness of breath and/or dizziness. Patients with MI had significantly more cardiac risk factors (2.4+/-0.2 vs 1.6+/-0.1; p = 0.006), lower presenting hematocrit (26.0+/-1.3 vs 30.5+/-0.8; p = 0.007), and lower lowest hematocrit in the first 48 h (22.3+/-0.9 vs 25.1+/-0.6; p = 0.01), and tended to have a longer ICU stays (7.9+/-2.2 vs 4.0+/-0.4 days; p = 0.09) than those without MI. Patients who had MI were not more likely to die during hospitalization (risk ratio = 1.8; 95% confidence interval, 0.6 to 5.8).
Myocardial infarction occurs frequently in patients admitted to intensive care with GI hemorrhage. A clinical history of and multiple risk factors for coronary artery disease may help identify patients who are at increased risk of MI, which tends to be associated with a higher acuity of illness and in-hospital mortality. Prospective studies are required to further substantiate these associations.
确定因胃肠道出血入住重症监护病房（ICU）的患者中心肌梗死（MI）的发生率及危险因素，以及MI对死亡率和住院时间的影响。
对我院ICU收治的胃肠道出血患者的病历进行回顾性分析。查阅病历中的各种人口统计学、实验室及预后参数。患者被分为发生MI、未发生MI或数据不足无法分类。
共回顾了230例因胃肠道出血入住ICU的病例。113例患者进行了系列肌酸磷酸激酶（CK）同工酶测定，可诊断MI。在这113例患者中，平均年龄为67.4±1.3岁，急性生理与慢性健康状况评分系统Ⅱ（APACHE II）平均评分为10.9±0.6。住院死亡率为13/113（11.5%）。未存活患者的入院APACHE II评分较高（15.8±2.0 vs 10.2±0.5；p = 0.02），初始收缩压较低（104.5±4.4 vs 121.2±3.2 mmHg；p = 0.005），ICU住院时间更长（8.3±1.8 vs 4.0±0.4天；p = 0.04）。113例患者中有16例符合MI的酶学和心电图标准。1例患者诉胸痛，16例中有9例有呼吸急促和/或头晕。发生MI的患者有更多的心脏危险因素（2.4±0.2 vs 1.6±0.1；p = 0.006），入院时血细胞比容较低（26.
