左主干病变导致急性心肌梗死合并心原性休克患者的近期预后  

Analysis on the short-term outcome of patients with acute myocardial infarction complicating cardiogenic shock due to left main disease

作　　者：郭超[1] 许浩博 段欣[1] 胡小莹[1] 张峻[1] 李佳[1] 高晓津[1] 罗晓亮[1] 杨伟宪[1] 胡奉环[1] 吴元[1] 乔树宾[1] Guo Chao;Xu Haobo;Duan Xin;Hu Xiaoying;Zhang Jun;Li Jia;Gao Xiaojin;Luo Xiaoliang;Yang Weixian;Hu Fenghuan;Wu Yuan;Qiao Shubin(Center of Coronary Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院冠心病诊治中心,100037

出　　处：《中华心血管病杂志》2019年第4期278-283,共6页Chinese Journal of Cardiology

摘　　要：目的探讨左主干病变导致急性心肌梗死合并心原性休克患者的近期预后。方法纳入2012年6月至2018年5月在阜外医院经急诊冠状动脉造影术证实罪犯血管为左主干的急性心肌梗死合并心原性休克患者24例,回顾性分析患者的临床资料,并在术后对患者进行随访。根据诊断休克后28 d是否死亡,将入选患者分为存活组(11例)和死亡组(13例)。根据术后冠状动脉血流心肌梗死溶栓试验(TIMI)分级,将入选患者分为TIMI 0~2级组(11例)和TIMI 3级组(13例)。根据冠状动脉造影结果,将入选患者分为非三支病变组(14例)和三支病变组(10例)。结果与存活组患者相比,死亡组患者入院24 h内最差收缩压较低[50(48,70)mmHg(1 mmHg=0.133 kPa)比73(70,80)mmHg,P<0.01],舒张压较低[(33.5±12.4)mmHg比(48.9±9.4)mmHg,P<0.01],呼吸频率较快[(27.3±2.5)次/min比(21.5±4.0)次/min,P<0.01],24 h尿量较少[(422±266)ml比(1 680±863)ml,P<0.01],血小板较低[(161.9±81.9)×109/L比(241.6±94.0)×10^9/L,P=0.03],血肌酐较高[(250.0±36.8)μmol/L比(132.7±34.2)μmol/L,P<0.01],丙氨酸氨基转移酶较高[288(76,846)IU/ml比81(42,109)IU/ml,P=0.04],动脉血pH值较低(7.11±0.17比7.39±0.09,P<0.01)、乳酸较高[(10.29±3.62)mmol/L比(4.21±2.85)mmol/L,P<0.01],气管插管比例较高(7/13比2/11,P=0.02),急性生理及慢性健康评价Ⅱ(APACHE Ⅱ)评分(35.4±6.8)分比(18.7±1.7)分,P<0.01]和简化急性生理学评分Ⅱ(SAPS Ⅱ)评分[(73.5±17.4)分比(47.0±4.3)分,P<0.01]较高,最终靶血管血流分级为TIMI 0~2级的比例较高(10/13比1/11,P<0.01)。Kaplan-Meier生存分析显示,TIMI 3级组患者诊断休克后28 d生存率高于TIMI 0~2级组患者(76.9%比9.1%,log-rank检验P<0.01),三支病变组与非三支病变组患者诊断休克后28 d生存率差异无统计学意义(35.7%比60.0%,log-rank检验P=0.14)。多因素logistc回归分析显示,与最终靶血管血流分级为TIMI 0~2级比较,最终靶血管血流分级为TIMI 3级的左主干病变�To investigate the short-term outcome of patients with acute myocardial infarction complicating cardiogenic shock due to left main disease. Methods A total of 24 patients with acute myocardial infarction complicating cardiogenic shock due to left main artery disease hospitalized in Fuwai hospital from June 2012 to May 2018 were included. The clinical data were analyzed,and the patients were divided into survivor group (11 cases) and death group (13 cases) according to survival status at 28 days post the diagnosis of shock. The patients were further divided into thrombolysis in myocardial infarction(TIMI) flow grade 0-2 group (11 cases) and TIMI flow grade 3 group (13 cases) according to TIMI flow grade after the procedure. The patients were then divided into non-three-vessel lesions group (14 cases) and three-vessel lesions group (10 cases) according to coronary angiography results. Results Compared with survivor group, patients in death group presented with lower worst systolic blood pressure within 24 hours after admission (50(48, 70) mmHg (1 mmHg=0.133 kPa) vs. 73(70, 80) mmHg, P<0.01), lower worst diastolic blood pressure with in 24 hours after admission ((33.5±12.4) mmHg vs.(48.9±9.4) mmHg, P<0.01), higher respiratory rates ((27.3±2.5) times/min vs.(21.5±4.0) times/min, P<0.01), less 24 hours urine output ((422±266) ml vs.(1 680±863) ml, P<0.01), lower platelet counts ((161.9±81.9)×109/L vs.(241.6±94.0)×10^9/L, P=0.03), higher serum creatinine ((250.0±36.8)μmol/L vs.(132.7±34.2)μmol/L, P<0.01), higher alanine aminotransferase (288(76,846) IU/ml vs. 81(42, 109) IU/ml, P=0.04), lower artery pH (7.11±0.17 vs. 7.39±0.09, P<0.01), higher lactic acid ((10.29±3.62) mmol/L vs.(4.21±2.85) mmol/L, P<0.01), higher incidence of invasive ventilation (7/13 vs. 2/11, P=0.02), higher scores of acute physiology and chronic health evaluation (APACHE)Ⅱ(35.4±6.8 vs. 18.7±1.7, P<0.01) and simplified acute physiology score (SAPS)Ⅱ(73.5±17.4 vs. 47.0±4.3, P<0.01), and higher incidence of target vessel TIM

关 键 词：心肌梗死 休克 心原性 预后 

分 类 号：R542.22[医药卫生—心血管疾病]