心臓リハビリテーションを実施した急性心筋梗塞患者の臨床的背景と入院経過について:——中年者, 前期高齢者, 後期高齢者の年代別比較—— Clinical Background and Hospitalization Progress in Patients with Acute Myocardial Infarction Who Experienced Cardiac Rehabilitation:——Comparison Among Age Groups——

〔目的〕AMI患者の臨床的背景と入院経過を中年者群，前期高齢者群，後期高齢者群で比較し，臨床的特徴を検討すること。<br>〔方法〕2009年4月から2011年3月の2年間にAMIで入院し，PCI後に心リハを実施した153例を対象とした。65歳未満を中年者群，65歳～75歳未満を前期高齢者群，75歳以上を後期高齢者群とし，3群間で臨床的背景 (責任冠動脈，CK最高値，LVEF，残存狭窄の有無，高血圧の有無，糖尿病の有無，脂質異常症の有無，喫煙の有無，BMI) ならびに入院経過 (心合併症の有無，運動器合併症の有無，200mECG異常，入院日数) を検討した。<br>〔結果〕対象者は中年者群84例，前期高齢者群44例，後期高齢者群25例に分類された。臨床的背景ではLVEFは後期高齢者群が前期高齢者に比べ有意に低く，残存狭窄は後期高齢者群で多かった。冠危険因子では，高血圧と糖尿病は3群ともに高率に合併し，脂質異常症は中年者群で多い傾向を示し，喫煙は中年者群で多かった。BMIは中年者群が後期高齢者群に比べ有意に高かった。入院経過に関しては，心合併症と運動器合併症の有無は後期高齢者群が多い分布形態で，入院日数は後期高齢者群が中年者群と前期高齢者群に比べ有意に長かった。<br>〔結論〕中年者群は二次予防を目的とした教育指導が重要で，後期高齢者群は合併症への対応とADLを上げるための運動療法と自宅退院への環境整備が重要である。

Purpose: To compare the effects of aging in patients with acute myocardial infarction (AMI) on their clinical background and hospitalization progress, and to examine the relationships between age and these factors.<br>Subject: One hundred and fifty-three patients who experienced cardiac rehabilitation after percutaneous coronary intervention (PCI) (63.8±11.1 y.o, 126 men, 27 women).<br>Method: The patients were divided into the middle aged group (<65 y.o, n=84), young old group (65 to 74 y.o, n=44), and old group (75 y.o≥ n=25). The differences between groups were examined in respect of 13 items about clinical backgrounds (responsibility coronary arteries, CKmax, LVEF, residual stenosis, hypertension, diabetes, hyperlipemia, smoking, and BMI) and hospitalization progress (cardiac complications, locomotorium disabilities, abnormality as 200mECG, and duration of hospitalization).<br>Results: Left veticular ejection fraction (LVEF) was significantly lower in the old group than in the young old group. The old group had a high rate of residual stenosis. In the coronary risk factors, all of the groups had hypertension at a high rate of 54.5% or over. The middle aged group and young old group had diabetes at about 38%. The middle aged group was prone to hyperlipemia, and had significantly a high smoking rate. Body mass index (BMI) was significantly higher in the middle aged group than in the old group. In hospitalization progress, the old group had a high rate of cardiac complications and locomotorium disability. The duration of hospitalization was significantly longer in the old group than in the other groups.<br>Conclusion: It would be necessary to give middle-aged persons educational guidance for the improvement of the coronary risk factors, and to provide the old persons with the suitable rehabilitation programs considering various complications.