急性下壁心肌梗死并心力衰竭的临床特征及预后  

Clinical features and prognosis of patients with acute inferior myocardial infarction complicated by heart failure

作　　者：高友山[1] 钱学贤[1] 马大波[2] 

机构地区：[1]第一军医大学珠江医院心内科,广州510282 [2]广州军区武汉总医院心内科

出　　处：《临床心血管病杂志》2001年第2期75-77,共3页Journal of Clinical Cardiology

摘　　要：目的 :分析急性下壁心肌梗死 (AIMI)并心力衰竭 (心衰 )的临床特征及预后。方法 :记录 180例AIMI患者中并心衰者的临床特征及住院并发症 ,行常规 12导联心电图及右胸导联心电图 ,并与无心衰者比较。结果 :AIMI并心衰者 41例 (占 2 2 .8% )。并心衰组较无心衰组年龄大〔6 5 .3± 10 .8)岁∶ (6 1.1± 10 .1)岁〕、肌酸激酶 (CK)峰值高〔(2 70 0 .4± 2 0 87.7) IU / L∶ (1879.1± 16 0 3.1) IU / L〕,右室梗死 (31.7%∶ 5 .8% )及高度房室传导阻滞 (39.0 %∶ 17.3% )发生率高 ,胸前导联 V4～ 6 ST段压低为主者比例高 (5 6 .1%∶ 2 4.5 % ) ,住院病死率高(4 6 .3%∶ 17.3% )。 L ogistic回归分析显示 AIMI并心衰与 CK峰值、右室梗死、胸前导联 V4～ 6 ST段压低及死亡率独立相关 ,而与年龄及高度房室传导阻滞不相关。结论 :AIMI并心衰者胸前 V4～ 6 导联 ST段压低及右室梗死发生率高 ,CK峰值高。 AIMI并心衰住院病死率高 ,预后差 ,为一高危亚组。Objective:To analyse the clinical features and in hospital prognosis of patients with acute inferior myocardial infarction (AIMI)complicated by heart failure.Method:One hundred and eighty consecutive patients with AIMI were analyzed. The clinical characteristics and in hospital mortalities of groups of patients with and without heart failure during AIMI were compared.Result:Among 180 AIMI patients,41 patients( 22.8 %) were complicated by heart failure. Compared with patients without heart failure, patients with heart failure were older( 65.3 ± 10.8 versus 61.1 ± 10.1 years,P< 0.05 ) and had a higher peak level of creatine kinase 〔( 2 700.4 ± 2 087.7 ) versus ( 1 879.1 ± 1 603.1 ) IU/L,(P< 0.05 )〕,a greater involvement of right ventricle( 31.7 % versus 5.8 %,P< 0.001 ),more advanced atrioventricular block( 39.0 % versus 17.3 %,P< 0.05 ),greater incidence of ST segment depression of V 4~6 precordial leads( 56.1 % versus 24.5 %,P< 0.01 ) and a higher in hospital mortality( 46.3 % versus 17.3 %,P< 0.001 ).Logistic analyses found that heart failure was related to peak level of creatine kinase, involvement of right ventricle, in hospital mortality and incidence of ST segment depression of V 4~6 precordial leads, but had no relation to age and advanced atrioventricular block.Conclusion:Patients with heart failure complicating AIMI had a higher incidences of ST segment depression of V 4~6 precordial leads and involvement of right ventricle as well as a higher peak level of creatine kinase. Groups with heart failure had a higher mortality, therefore, patients with heart failure complicating AIMI are a high risk group and have worse in hospital prognosis.

关 键 词：急性下壁心肌梗死 充血性心力衰竭 预后 并发症 临床特征 

分 类 号：R542.220.6[医药卫生—心血管疾病] R541.61[医药卫生—内科学]