急诊经皮冠状动脉介入术治疗急性心肌梗死患者术后低血压危险因素  

Risk factors of hypotension after emergency percutaneous coronary intervention in acute myocardial infraction patients

作　　者：胡怀岭[1] 李群[1] 姜椿法[1] 邱全煌[1] 

机构地区：[1]东莞市厚街医院急诊科,广东东莞523945

出　　处：《临床荟萃》2015年第1期13-16,共4页Clinical Focus

摘　　要：目的分析急诊行经皮冠状动脉介入术(PCI)治疗的急性心肌梗死患者术后发生低血压的危险因素。方法将我院收治的急诊行PCI治疗的急性心肌梗死患者165例分为术后低血压组和术后非低血压组两组,统计分析性别、年龄、高血压病、糖尿病、高血脂症、术前血压情况、心肌梗死病变位置等因素与低血压发生的相关性。结果165例急诊行PCI治疗的急性心肌梗死患者中PCI术后低血压发生率为38.8%。PCI术后低血压组中出现心肌缺血症状的患者显著低于PCI术后非低血压患者(21.9%vs 48.5%,P<0.01)。PCI术后低血压组肌酸激酶同工酶MB(CK-MB)峰值显著高于非低血压组,(247.3±186.8)U/L vs(175.4±159.6)U/L(P<0.05)。PCI术后低血压患者下壁心肌梗死和右室心肌梗死的患者均明显高于非低血压患者(62.5%vs 28.7%,P<0.01;12.5%vs 4.0%,P<0.05)。冠状动脉造影显示PCI术后低血压患者中完全闭塞、近段病变、右冠状动脉病变均高于术后非低血压患者(P<0.05)。PCI术后低血压患者术后TIMI分级<2级比例显著高于术后非低血压患者,差异有统计学意义(71.88%vs 4.95%,P<0.05)。对PCI术后患者低血压的危险因素进行logistic回归分析结果表明,心肌缺血症状是PCI术后患者低血压的保护性因素,而右冠状动脉病变、近段病变、完全闭塞、术后TIMI分级<2级均为PCI术后患者低血压的危险因素(P<0.05)。结论出现心肌缺血症状是PCI术后低血压发生的保护性因素,而右冠状动脉病变、近段病变、完全闭塞、术后TIMI分级<2级均为PCI术后患者低血压的危险因素,应该引起临床医生的高度重视。ABSTRACT：Objective To analyze the risk factors of hypotension after emergency percutaneous coronary intervention（PCI）in acute myocardial infraction patients.Methods Various clinical parameters were retrospectively analyzed in 165 acute myocardial infraction patients with emergency PCI in the hospital.The patients were divided into the hypotension group and non-hypotension group according to the occurrence of hypotension or not after emergency PCI.The observation indexes included gender,age,hypertension,diabetes,hyperlipemia,preoperative blood pressure and lesion location of acute myocardial infraction.Results The incidence of hypotension after operation in 165 acute myocardial infraction patients with emergency PCI was 38.8%. In the hypotension group, the patients who experienced symptoms of myocardial ischemia were obviously less than the non-hypotension group （21.9% vs 48.5%, P 〈0.01 ）.Compared with non-hypotension group,the peak value of creatine kinase isomer-MB（CK-MB）in the hypotension group was significantly decreased （247.3 ± 186.8）U/L vs （175.4 ± 159.6）U/L（P 〈0.05）.In the hypotension group, the patients with acute inferior myocardial infarction （IMI） or right ventricular myocardial infarction（RVMI）were apparently more than non- hypotension group （IMI 62.5% vs 28.7%,P 〈0.01;RVMI 12.5% vs 4.0%,P 〈0.05）.Coronary angiography showed that in the hypotension group,the incidences of total occlusion,proximal stenosis and stenosis in the right coronary artery were significantly more than non-hypotension group（P 〈0.05）.There were significant difference in the lesion types between two groups（P 〈0.05）.Logistic regression analysis showed that the symptom of myocardial ischemia was the protective factor against hypotension after operation,while total occlusion,proximal stenosis and stenosis in the right coronary artery and the TIMI grading after operation were the risk factors of hypotension after operation （P 〈0.05）.Conclusion Inferior myocardial infarct

关 键 词：心肌梗死 血管成形术 经腔 经皮冠状动脉 低血压 危险因素 

分 类 号：R541.4[医药卫生—心血管疾病]