急性心肌梗死合并心源性休克的临床特点和住院死亡影响因素分析  

Analysis about the Clinical Characteristics and Death Risk Factors in Acute Myocardial Infarction Patients with Cardiogenic Shock

作　　者：申立波 付美娇 陈璟[3] 何军[4] SHEN Libo;FU Meijiao;CHEN Jing;HE Jun(Cardiovascular Center of People's Hospital of Ningxia Hui Autonomous Region,Yinchuan 750002,China;Ningxia Medical University,Yinchuan 750004,China;Geriatrics and Special Needs Medicine,General Hospital of Ningxia Medical University,Yinchuan 750004,China;Department of Cardiology,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏回族自治区人民医院心血管中心,银川750002 [2]宁夏医科大学,银川750004 [3]宁夏医科大学总医院老年与特需医学科,银川750004 [4]宁夏医科大学总医院心内科,银川750004

出　　处：《宁夏医科大学学报》2022年第9期913-917,共5页Journal of Ningxia Medical University

基　　金：宁夏重点研发计划项目(2021BEG03115)。

摘　　要：目的探讨急性心肌梗死(acute myocardial infarction,AMI)合并心源性休克(cardiogenic shock,CS)患者的临床特点和住院死亡的影响因素。方法选取2009年1月至2018年12月宁夏医科大学总医院心内科收治的269例AMI合并CS且接受了急诊经皮冠状动脉内介入治疗术(PCI)的患者,根据住院转归分为存活组与死亡组,采用多因素Logistic回归模型分析住院死亡的独立影响因素。结果死亡组平均年龄[(66.20±10.78)岁]大于存活组[(60.62±11.39)岁](P<0.001)。死亡组合并原发性高血压、2型糖尿病者多于存活组(P均<0.05),心脏骤停、多器官衰竭及前壁心梗发生率死亡组均高于存活组(P均<0.01),下壁和右室梗塞发生率低于存活组(P均<0.01)。急性ST段抬高型心肌梗死(STEMI)占92.2%。死亡组基础血钾(K^(+))、血糖(Glu)、肌酐(Scr)、动脉血乳酸(Lac)、脑钠肽前体(NT-proBNP)水平均高于存活组(P<0.01),血钠(Na^(+))和左心室射血分数(LVEF)低于存活组(P<0.05)。罪犯血管为左前降支(LAD)或左主干(LM)者多见于死亡组(P均<0.05),罪犯血管为右冠脉(RCA)者多见于存活组(P<0.05)。胸痛至球囊扩张的中位时间死亡组长于存活组(P<0.01)。术后心肌梗死溶栓治疗血流分级(TIMI)0~2级者死亡组多于存活组(P<0.001)。死亡118例,病死率为43.9%。Logistic分析显示,年龄、Glu、Lac、Scr、LVEF、PCI术后TIMI血流<3级、前壁梗死是患者住院死亡的影响因素(P均<0.05)。结论AMI合并CS患者多伴有水电解质、酸碱和糖代谢紊乱,以及严重的心、肝、肾功能损害等临床特征,院内病死率高。年龄、血糖、动脉血乳酸、肌酐、LVEF、PCI术后TIMI血流<3级、前壁梗死是其住院死亡的影响因素。Objective To analyze the clinical characteristics and death risk factors in AMI patients with CS.Methods 269 AMI patients with CS who received emergency PCI in Department of Cardiology,General Hospital of Ningxia Medical University from January 2009 to December 2018 were selected and divided into the survival group and the death group according to hospitalization outcome.The independent risk factors of in-hospital death were explored by multivariate Logistic regression analysis.Results The average age of the death group was older than the survival group[(66.20±10.78)vs(60.62±11.39),P<0.001].The number of patients accompanied with hypertension and type 2 diabetes in the death group was more than that of the survival group(P all<0.05).Percentages of cardiac arrest,multi-organ failure and anterior wall infarction in the death group all increased compared with the survival group(P all<0.01).Acute ST segment elevation myocardial infarction(STEMI)accounted for 92.2%.The basic levels of potassium,glucose,lactose,creatinine,N-terminal pro-brain natriuretic peptide(NT-proBNP)in the death group were higher than those of the survival group(P<0.01),levels of sodium and left ventricle ejection fraction(LVEF)were lower than that of the survival group(P<0.05).The culprit vessels located in left anterior descending(LAD)or left main coronary artery(LM)were very common in the death group(P all<0.05),located in right coronary artery(RCA)were much common in survival group(P<0.05).The median duration of chest pain onset to ballooning in the death group was longer than that of the survival group(P<0.01).The patients with thrombolysis in myocardial infarction(TIMI)flow grade<3 after PCI in the death group were much more than that of the survival group(P<0.001).118 of them were died in hospital,the mortality was 43.9%.Logistic regression indicated that age,blood glucose,lactate,creatinine,LVEF,TIMI blood flow grade<3 post PCI and anterior wall infarction were the risk factors of in-hospital death(P all<0.05).Conclusion Patients with A

关 键 词：急性心肌梗死 心源性休克 经皮冠状动脉内介入治疗 住院病死率 影响因素 

分 类 号：R542.22[医药卫生—心血管疾病]