急性ST段抬高型心肌梗死患者入院即刻收缩压与住院期间不良事件关系的探讨  

Dissection of the admission systolic blood pressure for predicting outcomes during hospitalization in patients with ST-segment elevation myocardial infarction

作　　者：蔡濛 刘文娴[1,2] 赵晗[1,2] 任燕龙[1,2] 

机构地区：[1]首都医科大学附属北京安贞医院 [2]北京市心肺血管疾病研究所心内科监护室,100029 [3]北京积水潭医院干部病房

出　　处：《心肺血管病杂志》2015年第8期597-601,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的：探讨急性ST段抬高性心肌梗死（STEMI）患者,入院即刻SBP水平与住院期间发生心脏不良事件的关系。方法：连续入选2012年8月至2014年4月,发病24小时以内入院的（STEMI）患者1 799例,经排除标准筛选后共入选1 268例患者。记录入院即刻SBP,并根据SBP水平由低到高分为五组：1组90~100mm Hg（1mm Hg=0.133k Pa）、2组101~119mm Hg、3组120~139mm Hg、4组140~159mm Hg及五组≥160mm Hg组。分别包含患者数目为：250例（19.7%）,356例（28.1%）,437例（34.5%）,175例（13.8%）及50例（3.9%）。住院期间依据指南进行规范诊疗,观察终点为住院期间心性不良事件（死亡、心源性休克（CS）、心脏破裂、室性心动过速/心室颤动）的情况。结果：五组间死亡、心源性休克及室性心动过速/心室颤动发生率均差异具有统计学意义（P〈0.05）;其中各组全因病死率：五个组分别为8.8%、3.9%、3.2%、5.1%和6.0%;室性心动过速（CS）和室性心动过速/心室颤动发生率分别为19.2%、6.7%、3.4%、5.1%、0%、15.6%、9.0%、5.7%、5.7%和6.0%。入院即刻SBP为90~100mm Hg组具有更高的全因病死率（8.8%）、CS发生率（19.2%）及室性心动过速/心室颤动发生率（15.6%）。入院血压120~139mm Hg组具有更低全因病死率（3.2%）、CS发生率（3.4%）、室性心动过速/心室颤动发生率（5.7%）。多因素逻辑回归显示,入院即刻SBP 90~100mm Hg（OR=2.663,95%CI：1.597~4.439,P〈0.01）、Killip〉1级（OR=4.70,95%CI：2.804~7.869,P〈0.01）、IABP应用（A：OR=3.642,95%CI：2.382~5.568,P〈0.01/B：OR=3.277,95%CI：2.209~4.861,P〈0.01）为住院不良事件的独立危险因素。结论：STEMI患者入院即刻SBP水平与住院期间不良事件存在相关性,入院即刻SBP 90~100mm Hg住院不良事件率较高;而相对较高的血压（120~159mm Hg）住院不良事件率较低。Objective：Our study aimed to evaluate the effect of admission systolic blood pressure in predicting short-term outcomes during hospitalization in patients with ST-segment elevated myocardial infarction （STEMI）. Methods： 1 268 of 1 799 consecutive patients with STEMI, from August 2012 to April 2014, were enrolled after the exclusion criteria were applied. Patients were divided into 5 groups according to admission SBP categories ： admission SBP 90 - 100mmHg group（ lmmHg = 0. 133kPa,n = 250,19.7% ） ,admission SBP 101 - 119mmHg group（ n = 356,28.1% ） ,admission SBP 120 - 139mmHg group（ n = 437,34. 5% ） ,admission SBP 140 - 159mmHg group（ n = 175,13. 8% ） and admission SBP ≥ 160mmHg group （ n = 50,3. 9% ）. The clinical characteristics, procedural characteristics, and in-hospital adverse events were recorded. The major end points were adverse events composite of deaths, cardiogenic shock, cardiac rupture , ventricular tachycardia and ventricular fibrillation during hospitalization. Results：There was a significant different in all-cause mortali- ty, cardiogenie shock and ventricular tachycardia/ventricular fibrillation among the 5 groups （ P 〈 0. 05 ）. In hospital all-cause mortality rates according to admission SBP categories were 8. 8% ,3.9% , 3.2% , 5. 1% and 6. 9%, respectively. The Cardiogenic shock rates according to admission SBP categories were 19. 2% ,6. 7% , 3.4, 5.1% , and 0% , respectively. The ventrieular tachycardia/ventrieular fibrillation rates according to admission SBP categories （90 - 100mmHg, 101 - ll9mmHg, 120 - 139mmHg, 140 - 159mmHg, and 1〉 160mmHg） were 15.6% ,9. 0% , 5.7% , 5.7% and 6.0% , respectively. Those who presented with admission SBP 90-100mmHg had higher incidence of all-cause mortality（ 3.2% ） , cardiogenic shock（3.4% ）and ventricular tachycardia/ventrieular fibrillation（ 15.6% ）. On the contrary, admission SBP 120-139mmHg group had lower incidence in these end points. Independent predictors for in-hospital adverse events were a

关 键 词：ST段抬高心肌梗死 入院收缩压 住院不良事件 

分 类 号：R54[医药卫生—心血管疾病]