急性心肌梗死后心功能受损患者并发急性脑梗死的危险因素分析  

Risk factors of acute cerebral infarction in patients with cardiac dysfunction after acute myocardial infarction

作　　者：郑高暑[1] 周晓东 计光[1] 单培仁[1] 李晟[1] 周浩[1] ZHENG Gaoshu;ZHOU Xiaodong;JI Guang;SHAN Peiren;LI Sheng;ZHOU Hao(Department of Cardiology,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]温州医科大学附属第一医院心血管内科,325000

出　　处：《浙江医学》2021年第11期1226-1230,共5页Zhejiang Medical Journal

摘　　要：目的探讨急性心肌梗死(AMI)后心功能受损患者并发急性脑梗死(ACI)的危险因素及防治措施。方法选择2009年12月至2019年10月温州医科大学附属第一医院收治的AMI后心功能受损并发ACI患者123例(观察组),另择同期收治的单纯心肌梗死后心功能受损患者415例为对照组。收集患者高血压、糖尿病、高脂血症、脑梗死病史及用药史等一般资料;行心脏彩超检查,记录左心室舒张末期内径、左心房内径、肺动脉收缩压、左心室射血分数及左心室收缩活动减弱部位等指标;行血生化检查记录各项生化指标。采用多元logistic回归分析两组AMI的相关危险因素。结果观察组有高血压、糖尿病、脑梗死病史及心房颤动比例高于对照组,而抗血小板药物使用比例低于对照组,差异均有统计学意义(均P<0.05)。观察组左心室前壁+整体收缩活动减弱比例、肺动脉收缩压较对照组高,下壁收缩活动减弱比例、左心室射血分数、HDL-C水平均较对照组低,差异均有统计学意义(均P<0.05)。logistic回归分析显示高血压、糖尿病、抗血小板药物使用、左心室前壁+整体收缩活动减弱、左心室射血分数、肺动脉收缩压均为AMI后并发ACI的危险因素(均P<0.05)。结论AMI后心功能受损患者维持较好的左心室收缩功能且规律服用抗血小板药物对于预防ACI具有一定的意义。Objective To analyze the risk factors of cerebral infarction in patients with cardiac dysfunction after acute myocardial infarction.Methods From December 2009 to October 2019,123 patients with cardiac dysfunction after myocardial infarction complicated with cerebral infarction(study group)and 415 patients with simple cardiac infarction(control group)admitted to the First Affiliated Hospital of Wenzhou Medical University,were included in the study.General data on hypertension,diabetes and hyperlipidemia of patients was collected.Heart colour Doppler ultrasound was performed and d left ventricular end-diastolic internal diameter,left atrial internal diameter,pulmonary artery systolic pressure,left ventricular ejection fraction and weakened sites of left ventricular systolic activity were documented.Blood-biochemical tests were conducted.Risk factors for cerebral infarction of two groups were analyzed with multiple logistic regression.Results Compared to control group,the proportion of patients with hypertension,diabetes,history of cerebral infarction and atrial fibrillation in the study group was significantly higher,while the proportion of taking antiplatelet drugs in the study group was lower(all P<0.05).Compared to control group,the proportion of weakened anterior+entirely systolic activity in the left ventricles,pulmonary artery systolic pressure was higher in the study group;the proportion of weakened inferior systolic activity in the left ventricles,left ventricular ejection fraction and levels of high density lipoprotein cholesterol was lower(all P<0.05).Logistic analysis showed that hypertension,diabetes,weakened anterior+entirely systolic activity in the left ventricles,not-taking antiplatelet drugs,lower left ventricular ejection fraction,and higher pulmonary artery systolic pressure were significantly associated with the risk of cerebral infarction(all P<0.05).Conclusion Maintaining a better left ventricular systolic function and regular taking antiplatelet drugs in patients with cardiac dysfunction afte

关 键 词：急性心肌梗死 急性脑梗死 危险因素 左心室功能障碍 肺动脉收缩压 

分 类 号：R542.22[医药卫生—心血管疾病] R743.33[医药卫生—内科学]