昼夜节律对急性ST段抬高型心肌梗死患者院内心血管事件的影响  

Effect of circadian rhythm on nosocomial cardiovascular events in patients with acute ST segment elevation myocardial infarction

作　　者：王欢[1] 王云帆[1] 孙秀华[1] 张庆刚[1] 王利宏[1] 车贤达[1] 屈百鸣[1] Wang Huan;Wang Yunfan;Sun Xiuhua;Zhang Qinggang;Wang Lihong;Che Xianda;Qu Baiming(Department of Cardiology,Zhejiang Provincial People＇s Hospital,Hangzhou 310014,China)

机构地区：[1]浙江省人民医院心内科,杭州310014

出　　处：《中华危重症医学杂志（电子版）》2018年第3期174-177,共4页Chinese Journal of Critical Care Medicine:Electronic Edition

基　　金：浙江省医药卫生科技项目(2018241580);浙江省中医药科技计划项目(2015ZB008)

摘　　要：目的研究昼夜节律对急性ST段抬高型心肌梗死(STEMI)患者院内心血管事件发生率的影响。方法收集2016年1月至2017年12月就诊的STEMI患者212例,根据发病时间将患者分为上午组(84例)、下午组(64例)及夜间组(64例),比较三组患者住院期间的主要心血管不良事件(MACE)和次要心血管不良事件发生情况,并采用Logistic回归模型对STEMI患者住院期间MACE的影响因素进行分析。结果夜间组MACE[20.0%(13/64)、6.0%(5/84)、7.8%(5/64)]及恶性心律失常[18.8%(12/64)、2.4%(2/84)、4.7%(3/64)]发生率均显著高于上午组及下午组(P均<0.017),而上午组及下午组之间比较,差异均无统计学意义(P均>0.017)。而三组患者间心功能不全、心律失常和出血发生率比较,差异均无统计学意义(χ2=0.696、1.601、2.555,P=0.706、0.449、0.279)。多因素Logistic结果显示夜间发病是STEMI患者住院期间发生M ACE的危险因素[OR=3.736,95%CI(1.172,11.902),P=0.028]。结论夜间发病会增加STEMI患者院内发生MACE的风险。Objective To study the effect of circadian rhythm on the incidence of nosocomial cardiovascular events in patients with acute ST segment elevation myocardial infarction（STEMI）. Methods Totally 212 patients with STEMI from January 2016 to December 2017 were divided into the morning group（84 cases）, afternoon group（64 cases） and night group（64 cases） accroding to the onset of disease. The incidences of major cardiovascular adverse events（MACE） and minor cardiovascular adverse events during hospitalization were compared among three groups. The relative risk of MACE in STEMI patients was analyzed by Logistic regression.Results The incidences of MACE [20.0%（13/64）, 6.0%（5/84）, 7.8%（5/64）] and malignant arrhythmia [18.8%（12/64）, 2.4%（2/84）, 4.7%（3/64）] in the night group were much higher than those in the morning group and afternoon group（all P〈0.017）, while no difference was noted between the morning group and afternoon group（all P〉0.017）. However, there were no significant differences in the incidences of cardiac insufficiency, arrhythmia and hemorrhage among three groups（ χ^2= 0.696, 1.601, 2.555; P = 0.706, 0.449, 0.279）. The multivariate Logistic regression model showed that the nocturnal onset [OR = 3.736, 95%CI（1.172, 11.902）, P = 0.028] was a risk factor for MACE during hospitalization in STEMI patients. Conclusion The nocturnal onset will increase the risk of MACE during hospitalization in STEMI patients.

关 键 词：昼夜节律 心肌梗死 心血管事件 危险因素 

分 类 号：R542.22[医药卫生—心血管疾病]