急性心肌梗死患者PTCA术后效果评价及预后影响因素分析  

Effect evaluation and prognostic factors analysis of PTCA in patients with acute myocardial infarction

作　　者：陈燕 何清[1] 陈剑飞 韩霞 CHEN Yan;HE Qing;CHEN Jian-fei(Department of Cardiovascular Medicine,Banan District People's Hospital,Chongqing 401320,China)

机构地区：[1]重庆市巴南区人民医院心血管内科,重庆401320

出　　处：《临床和实验医学杂志》2022年第1期36-39,共4页Journal of Clinical and Experimental Medicine

基　　金：重庆市科卫联合医学科研项目(编号:2020GDC16)。

摘　　要：目的评价急性心肌梗死(AMI)患者行经皮冠状动脉腔内血管形成术(PTCA)后的治疗效果,探讨影响AMI患者预后的相关影响因素,为预测和改善AMI患者预后提供科学依据。方法回顾性收集2017年9月至2020年3月重庆市巴南区人民医院收治的129例急性心肌梗死患者的相关资料,根据发生不良心血管事件(MACE)情况将其分为MACE组(n=39)和无MACE组(n=90)。分析患者PTCA手术前后心功能指标的改变,比较两组患者相关资料的差异,采用多因素Logistic回归模型分析AMI患者预后的影响因素并绘制风险列线图。结果行PTCA手术治疗后,患者的平均左心室射血分数(LVEF)、左室舒张末期内径(LVEDd)及QT间期离散度(QTd)为(53.60±9.94)%、(53.80±7.43) mm、(45.34±6.80) ms,均较术前[(40.96±6.49)%、(56.93±4.08) mm、(66.88±7.81) ms]显著改善,差异均有统计学意义(P <0.05)。MACE组患者年龄、高血压史、冠心病家族史和吸烟史患者占比、QT间期离散度、血红蛋白和N末端脑钠肽前体(NT-pro BNP)水平均高于无MACE组,Killip分级Ⅰ级患者占比、术后LVEF均低于无MACE组,差异均有统计学意义(P <0.05)。多因素Logistic回归分析结果提示年龄(OR=1.132,95%CI:1.038~1.234)、高血压(OR=4.031,95%CI:1.013~16.029)、Killip分级(OR=3.850,95%CI:1.479~10.023)、术后LVEF(OR=0.938,95%CI:0.811~0.999)和术后QT间期离散度(OR=1.491,95%CI:1.263~1.760)均是患者预后的影响因素。结论 AMI患者行PTCA术后可显著改善患者症状,同时AMI患者的年龄、高血压史、Killip分级情况、术后LVEF水平、QT间期离散度均是患者预后的影响因素。Objective To evaluate the therapeutic effect of percutaneous coronary intraluminal angiogenesis( PTCA) on patients with acute myocardial infarction( AMI),and to explore the related factors affecting the prognosis of AMI patients,so as to provide scientific basis for predicting and improving the prognosis of AMI patients. Methods The data of 129 patients with acute myocardial infarction admitted to the People’s Hospital of Chongqing Banan District from September 2017 to March 2020 were retrospectively collected. According to the occurrence of adverse cardiovascular events( MACE),they were divided into MACE group( n = 39) and non-MACE group( n = 90). The changes of cardiac function indexes before and after PTCA were analyzed,and the differences in relevant data between the two groups were compared. The factors influencing the prognosis of AMI patients were analyzed by using multi-factor Logistic regression model and the risk graph was drawn. Results After PTCA,the patients’ mean left ventricular ejection fraction( LVEF),left ventricular end-diastolic diameter( LVEDd) and QT interval dispersion( QTd) were( 53. 60 ± 9. 94) %,( 53. 80 ± 7. 43) mm,( 45. 34 ± 6. 80) ms,which significantly improved when compared with preoperative[( 40. 96 ± 6. 49) %,( 56. 93 ± 4. 08) mm,( 66. 88 ± 7. 81) ms],the differences were statistically significant( P < 0. 05). The age,hypertension history,family history of coronary heart disease,and smoking history,QT interval dispersion,hemoglobin and N-terminal pro-brain natriuretic peptide( NT-proBNP) levels in the MACE group were higher than those in the non-MACE group,the proportion of patients with Killip grade I and the postoperative LVEF were lower than those non-MACE group,and the differences were statistically significant( P < 0. 05). Multivariate Logistic regression analysis results showed that age( OR = 1. 132,95% CI : 1. 038 ~ 1. 234),hypertension( OR = 4. 031,95% CI :1. 013 ~ 16. 029),Killip classification( OR = 3. 850,95% CI : 1. 479 ~ 10. 023),postoperative LVEF( OR = 0.

关 键 词：急性心肌梗死 经皮冠状动脉腔内血管形成术 预后因素 

分 类 号：R542.22[医药卫生—心血管疾病]