PCI治疗STEMI发生再灌注损伤的危险因素分析  

Analysis of risk factors of reperfusion injury of STEMI treated by PCI

作　　者：张欣 李小玲[1] ZHANG Xin;LI Xiaoling(Department of Cardiology,Tongde Hospital of Zhejiang Province,Hangzhou310012,China)

机构地区：[1]浙江省立同德医院心血管科,浙江杭州310012

出　　处：《中国现代医生》2021年第25期10-12,23,共4页China Modern Doctor

基　　金：浙江省中医药科技计划项目(2017ZA022)。

摘　　要：目的 探讨PCI治疗STEMI发生再灌注损伤的危险因素。方法 选择2018年1月至2020年6月在我院行PCI治疗的162例STEMI患者的临床资料进行回顾性分析。记录患者间一般资料及临床资料,包括患者性别、年龄、吸烟史、BMI、高血压史、糖尿病史、卒中病史、心血管疾病家族史;发病至就诊时间、罪犯血管、入院时的血压值、BUN、Scr、BNP、CK、CK-MB、TC、TG、LDL-C、HDL-C,术后次日FBG、cTnI、cTnT等,单因素及多因素分析PCI治疗STEMI发生再灌注损伤的影响因素。结果 ①单因素分析显示,罪犯血管为右冠状动脉,入院时收缩压<140 mm Hg的患者IRI发生率更高(P<0.05);IRI组患者BNP、CK、CK-MB、cTnI、cTnT水平更高,差异有统计学意义(P<0.05);②多因素分析显示,罪犯血管为右冠状动脉、入院时收缩压<140 mmHg、BNP、CK、CK-MB、cTnI、cTnT水平是PCI治疗STEMI发生再灌注损伤的独立危险因素(OR=6.129、3.532、3.811、4.104、3.967、4.627、4.380,P<0.05)。结论 PCI治疗STEMI发生再灌注损伤的危险因素包括罪犯血管为右冠状动脉,入院时收缩压下降,BNP、CK、CK-MB、cTnI、cTnT水平等,提示患者的疾病严重程度与再灌注损伤密切相关。Objective To explore the risk factors of reperfusion injury of STEMI treated by PCI.Methods The clinical data of 162 STEMI patients who underwent PCI treatment in our hospital from January 2018 to June 2020 were retrospectively analyzed.The patient′s general information and clinical data were recorded,including patient gender,age,smoking history,BMI,history of hypertension,history of diabetes,history of stroke,family history of cardiovascular disease,time from onset to treatment,blood vessels of the offender,blood pressure,BUN,Scr,BNP,CK,CK-MB,TC,TG,LDL-C,and HDL-C at admission,the FBG,cTnI,cTnT the next day after surgery.Single factor and multiple factors were used to analyze the influencing factors of reperfusion injury in STEMI treated by PCI.Results①Univariate analysis showed that the culprit′s vessel was the right coronary artery,and the incidence of IRI was higher in patients with systolic blood pressure<140 mmHg at admission(P<0.05),the levels of BNP,CK,CK-MB,cTnI,cTnT in the IRI group were higher,and the difference was statistically significant(P<0.05).②The results of multivariate analysis showed that the culprit′s blood vessel being the right coronary artery and the systolic blood pressure<140 mmHg on admission,BNP,CK,CK-MB,cTnI,and cTnT levels were independent risk factors for reperfusion injury in STEMI treated with PCI(OR=6.129,3.532,3.811,4.104,3.967,4.627,4.380,P<0.05).Conclusion The risk factors for reperfusion injury in STEMI treated by PCI include the culprit′s blood vessel being the right coronary artery,decreased systolic blood pressure at admission,and levels of BNP,CK,CK-MB,cTnI,and cTnT.This study indicates that the severity of the patient′s disease is closely related to reperfusion injury.

关 键 词：急性ST段抬高型心肌梗死 PCI 心肌缺血后再灌注损伤 危险因素 

分 类 号：R542.22[医药卫生—心血管疾病]