章陈晨　宋双双　刘凌琳

[摘要] 目的 探讨老年慢性阻塞性肺疾病（COPD）急性加重期（AECOPD）合并急性心肌梗死（AMI）患者的心脏功能变化与预后评价。 方法 选择2015年10月～2017年8月西南医院老年特诊科收治的老年AECOPD合并AMI患者30例作为观察组，另选择同期单纯AMI无COPD急性加重期的患者30例作为对照组。分别用超声心动图检测两组患者心功能相关指标以及右心结构指标，并进行血气分析，检测心肌损伤标志物，记录并发症的发生率及病死率。 结果 观察组血氧分压水平显著低于对照组（P < 0.01），二氧化碳分压、肌酸激酶同工酶、肌钙蛋白T、B型钠尿肽前体水平显著高于对照组（P < 0.01）；观察组左室射血分数显著低于对照组（P < 0.01），右心功能相關指标中观察组患者右室舒张末容积、右室收缩膜容积、右室每搏输出量显著高于对照组（P < 0.01），右室射血分数显著低于对照组（P < 0.01）；观察组右心结构相关指标肺动脉内径、舒张末期右心室内径、右室前壁厚度及右室心肌做功指数（Tei指数）显著高于对照组（P < 0.01）；观察组电解质紊乱、肺部感染、心力衰竭、心源性休克、呼吸衰竭的发生率显著高于对照组（P < 0.05），但两组病死率差异无统计学意义（P > 0.05）。 结论 AECOPD合并AMI早期即可发生心室重构、心肌肥大，且可进一步导致AMI患者心功能进一步恶化，严重影响近期预后。

[关键词] 慢性阻塞性肺疾病急性加重期；急性心肌梗死；心功能；预后

[中图分类号] R563.9 [文献标识码] A [文章编号] 1673-7210（2018）07（b）-0096-04

[Abstract] Objective To investigate the changes of right ventricular function and prognosis evaluation in elderly patients with acute exacerbation of chronic obstructive pulmonary diseases （COPD） and acute myocardial infarction （AMI）. Methods From October 2015 to August 2017， in Department of Geriatric， Southwest Hospital， Army Medical University， 30 elderly patients with acute exacerbation of COPD （AECOPD） and AMI patients were selected as the observation group， 30 cases of AMI elderly patients without AECOPD were selected as the control group， heart function index and right heart structure index of two groups were respectively tested by echocardiography， blood gas analysis and detection of myocardial injury markers， morbidity and mortality rate of complications were recorded. Results The PaO2 level of the observation group was significantly lower than the control group （P < 0.01）， PaCO2， CK-MB cTnT and pro-BNP were significantly higher than the control group （P < 0.01）； LVEF of the observation group was significantly lower than the control group （P < 0.01）， the relevant indicators of the right ventricular function （RVEDV， RVESV and RVSV） of the patients in the observation group were significantly higher than the control group （P < 0.01）， and RVEF was significantly lower than the control group （P < 0.01）； PAD， RVED， RVAWT and Tei index of the observation group were significantly higher than the control group （P < 0.01）； the electrolyte disorders， pulmonary infection， the incidence of heart failure， cardiogenic shock and respiratory failure of the observation group were significantly higher than the control group （P < 0.05）， and there was no significantly difference in the mortality between the two groups （P > 0.05）. Conclusion AECOPD with AMI can lead to ventricular remodeling and cardiac hypertrophy early， which can further lead to further deterioration of cardiac function in AMI patients， and seriously affect the short-term prognosis.

[Key words] Acute exacerbation of chronic obstructive pulmonary diseases； Acute myocardial infarction； Cardiac function； Prognosis

急性心肌梗死（AMI）是临床上因持续且严重的心肌缺血导致的心肌细胞坏死，患者可表现为持续的胸部剧痛、心律失常、急性血液循环障碍、心功能衰竭、心肌酶谱指标增高以及心电图病理性改变等，极易发生各类心律失常及心脏停搏[1-2]。慢性阻塞性肺疾病（COPD）是临床上慢性气道阻塞，以呼气性呼吸困难为特征的一类肺功能不全性疾病，可进展为劳力性呼吸困难，引起右心扩张、肥大，并诱发心力衰竭[3-4]。本研究对老年COPD急性加重期（AECOPD）合并急性心肌梗死患者其心功能及预后的影响评价进行研究，为临床上AECOPD合并AMI的临床诊断和治疗提供依据，现报道如下：

1 资料与方法

1.1 一般资料

选择2015年10月～2017年8月西南医院老年特诊科收治的老年AECOPD合并AMI患者30例为观察组，其中男18例，女12例；……