STEMI患者早期接受β受体阻滞剂治疗的相关因素  

Factors associated with early beta-blockers treatment in ST-elevation myocardial infarction patients

作　　者：何蕾[1] 李蓓[1] 李方[1] 钟建利[1] 刘成伟[1] 吴明祥[1] 苏晞[1] HE Lei LI Bei LI Fang et al(Coronary Care Unit, Wuhan Asia Heart Hospital, Wuhan 430022, Chin)

机构地区：[1]武汉亚洲心脏病医院心内科,湖北省武汉市430022

出　　处：《中国心血管病研究》2016年第8期709-712,共4页Chinese Journal of Cardiovascular Research

基　　金：北京力生心血管健康基金会2014中国心血管疾病药物治疗研究基金项目优秀课题资助（项目编号：LSG2014-2015）

摘　　要：目的 探讨STEMI患者院内早期接受β受体阻滞剂（BBs）治疗的相关因素.方法 纳入2015年6～9月期间人住我院CCU符合入选标准的STEMI患者186例.比较早期治疗组（24h内接受BBs）与延迟治疗组（＞24 h接受BBs）的临床资料,进一步采用Logistic回归分析早期治疗组的相关因素.结果 ①186例患者中早期治疗组148例（80％）,延迟治疗组38例,平均年龄（59.28±11.55）岁,男性134例（72％）,接受直接PCI治疗115例（61.83％）.②早期治疗组与延迟治疗组相比,患者年龄小[（57.51±10.45）岁比（61.61±10.69）岁,P=0.033]、多合并高血压病史（59.46％比34.21％,P=0.005）、入院时SBP较高[（135.63±23.99）mm Hg比（119.32±21.40）mm Hg,P=0.000]、HR较快[（83.53±16.55）次/min比（76.87±15.53）次/min,P=-0.026]、killip分级P=0.032、心梗部位P=0.000、肌酐水平低[（74.85±23.83） μmol/L比（87.26± 19.71）μmol/L,P=0.003]及eGFR高[（107.55±31.21）ml·kg-1·min-1比（86.84±30.54）ml·kg-1·min-１,P=0.000].③采用二分类Logistic回归方法分析显示,合并高血压病史、入院SBP、入院HR、eGFR是早期接受BBs治疗的相关因素;而下后壁心肌梗死患者不易早期接受BBs.结论 高血压病史、入院SBP高、入院HR快、eGFR高是STEMI患者院内早期接受β受体阻滞剂治疗的相关因素.Objective Current guidelines recommend early oral beta-blocker administration in the management of ST-elevation myocardial infarction for patients who are not at high risk of complications. The objectives of this present observational study were to identify factors associated with early beta-blockers treatment. Methods A total of 186 STEMI patients hospitalized in CCU were included from Jane 2015 to September 2015. Comparisons were made between early（first 24 hours） treatment group and delayed（after first 24 hours） treatment group with regard to baseline characteristics and clinical presentation. Results （1）Among 186 patients, 80% received early beta-blockers, and 20% received delayed （〉24 hours） beta-blockers. The mean age was （59.28±11.55）years and 134 （72%） males, 115 （61.83%） patients underwent primary percutaneous coronary intervention （PPCI）. （2）Compared to delayed treatment group, early treatment group had significant differences in younger patients [ （57.51± 10.45）years vs （61.61±10.69）years, P=-0.033], history of hypertension （59.46% vs 34.21%, P=0.005）, higher systolic blood pressure[（135.63±23.99）mm Hg vs （119.32±21.40）mm Hg, P=0.000], higher heart rate[（83.53± 16.55 ）times/rain vs （76.87±15.53）times/min, P=0.026 ], Killip class （P-=0.032）, location of ST-segment elevation （P=0.000）, lever of ereatinine [ （74.85±23.83）μmol/L vs （87.26±19.71）μmol/L, P=0.003] and eGFR [ （107.55±31.21）ml·kg-1·min-1 vs （86.84±30.54）ml·kg-1·min-1, P=0.000]. （3）A binary logistic regression model predicting early beta-blocker treatment relevant variables were history of hypertension, higher systolic blood pressure, higher heart rate and eGFR. Early beta-blocker use was less likely in patients with inferior myocardial infarction. Conclusion History of hypertension, higher systolic blood pressure, higher heart rate, and eGFR were independent predictors of early beta-blocker use.

关 键 词：急性ST段抬高型心肌梗死 Β受体阻滞剂 

分 类 号：R542.22[医药卫生—心血管疾病]