影响急性心肌梗死后左心室功能不全的多因素分析  

MULTIVARIATE ANALYSIS OF LEFT VENTRICULAR DYSFUNCTION AFTER ACUTE MYOCARDIAL INFARCTION

作　　者：王洁[1] 盖鲁粤[1] 杜洛山[1] 姚晨[1] 

机构地区：[1]解放军总医院

出　　处：《解放军医学杂志》2002年第7期590-592,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：寻找对急性心肌梗死 (AMI)后远期心功能状态有显著影响意义的独立危险因素。作者对解放军总医院 1988年 1月 1日～1998年 6月 30日AMI并行冠状动脉造影检查的连续病例进行了回顾性追踪分析。符合入选标准 15 5例。10年中AMI出院后心源性死亡 7例 ,占 4 5 %。Logistic多元回归分析显示 :年龄、高血压、高血脂症、冠脉病变支数、心肌梗死时LVEF、溶栓治疗以及经皮经冠状动脉成形术 (PTCA)治疗是对AMI远期心功能不全的发生有显著影响意义的因素。COX回归分析显示 :溶栓治疗、PTCA治疗、梗死面积、冠脉病变支数以及高脂血症是对心肌梗死后发生心功能不全的时间有显著影响的因素。研究表明 ,随着梗死后时间的延长 ,心功能不全的发生概率逐年增高。高龄、高血压、高脂血症、大面积心肌梗死、多支血管病变、AMI后早期LVEF受损、没有行早期再灌注治疗 (溶栓和急诊PTCA)以及AMI后没有行择期PTCA是对AMI后远期心功能状态有显著影响意义的危险因素。The aim of this study was to investigate factors contributing to left ventricular dysfunction (LVD) in patients who had survived acute myocardial infarction(AMI). Retrospective regression analysis was performed for all the hospitalized patients with AMI who underwent coronary angiography from 1988 to 1998. 155 patients met the entry criteria. Seven patients(4 5%) died of cardiac events after discharge during the ten years′ follow up. In the multivariate logistic regression analysis and stepwise selection, the following factors appeared to be the significantly independent predictors of the LVD after AMI : age, hypertension, hyperlipidemia, LVEF during the first admission, size of infarction, the number of vessel disease, thrombolytic therapy, PTCA. In the COX regression and stepwise selection, the following factors appeared to be significantly independent predictors of the LVD after AMI : hyperlipidemia, LVED during the first admission, size of infarction, the number of vessel disease, thrombolytic therapy , PTCA. The probability of LVD increased with time. Patients with advanced age, hypertension, hyperlipidemia, large infarction, multivessel disease, reduced LVEF after AMI, no thrombolysis and PTCA are prone to develop LVD.

关 键 词：急性心肌梗死 左心室功能障碍 多因素分析 AMI 经皮冠状动脉腔内成形术 影响因素 

分 类 号：R542.22[医药卫生—心血管疾病]