心肌梗死患者经皮冠状动脉介入治疗后的预后状况观察  

Long-term follow-up observation and predictive factor analysis of complications after percutaneous coro⁃nary intervention in patients with myocardial infarction

作　　者：贺翠[1] 陈春萍[1] 赵喜兰[1] 张晓玲[1] 李永琼[1] HE Cui;CHEN Chun-ping;ZHAO Xi-lan;ZHANG Xiao-ling;LI Yong-qiong(Department of Cardiovascular Medicine,Fuling Central Hospital,Chongqing 408000,China)

机构地区：[1]重庆市涪陵中心医院心血管内科,重庆408000

出　　处：《岭南心血管病杂志》2022年第5期403-406,416,共5页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨心肌梗死患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后预后状况及其影响因素。方法以2018年5月至2019年9月期间重庆市涪陵中心医院心内科住院部确诊为心肌梗死的患者105例作为研究对象。患者于住院期间进行PCI治疗,全部患者持续随访≥3个月,观察长期随访期间并发症发生情况。采用病例比较法,分析影响并发症的独立预测因素。结果随访期间21例患者出现并发症,其发生率为20%,其中心脏相关并发症占47.62%,心脏不相关并发症占52.38%。与对照组比较,并发症组女性、年龄、体质量指数(body mass index,BMI)、心率、原发性高血压(高血压)、糖尿病、脑卒中、心律失常、肾功能不全、贫血和多血管病变及心功能指标[肌酸激酶同工酶(creatine kinase isoenzyme MB,CK-MB)、肌钙蛋白T(troponin T,TnT)、左心室舒张末期内径(left ventricular end-diastolic diameter,LVEDD)]均明显增高,完全血运重建和左心室射血分数(left ventricular ejection fraction,LVEF)明显降低,差异有统计学意义(P<0.05)。经多因素Cox回归分析结果显示,完全血运重建是保护因素(OR=0.313,P<0.05),女性、年龄≥60岁、心率≥75次/min、高血压、糖尿病、脑卒中、心律失常、肾功能不全、贫血、多血管病变、CK-MB≥30 U/L、TnT≥0.5 ng/L、LVEF≤50%、LVEDD≥50 mm均为危险因素(OR>1,P<0.05)。结论心肌梗死PCI治疗后患者预后状况欠佳,其中高龄、基础病、心率及心功能指标异常是心肌梗死PCI治疗后患者预后欠佳的危险因素,而完全血运重建是保护因素。Objectives To investigate the risk factors of complications during long-term follow-up after percutaneous coronary intervention(PCI)in patients with myocardial infarction.Methods A total of 105 patients with myocardial infarction diagnosed in cardiology inpatient department of Fuling Central Hospital from May 2018 to September 2019 were selected as study subjects and underwent PCI during hospitalization.All the patients were followed-up≥3 months and complications were observed during long-term follow-up.Independent predictors of complications were analyzed by case comparison.Results During follow-up,21 cases occurred complications,the rate was 20%,cardiac related complications accounted for 47.62%,and cardiac unrelated complications accounted for 52.38%.Compared with control group,the proportions of women,body mass index(BMI),hypertension,diabetes,stroke,cardiac arrhythmias,renal insufficiency,anemia,multivessel disease,average age,heart rate,creatine kinase isoenzyme MB(CK-MB),troponin T(TnT),left ventricular end-diastolic diameter(LVEDD)of complication group were significantly higher,complete revascularization and left ventricular ejection fraction(LVEF)were significantly lower(P<0.05).Multivariate Cox regression analysis showed that,women,aged≥60 years,heart rate≥75 beats per min,hypertension,diabetes,stroke,arrhythmia,renal insufficiency,anemia,multivessel disease,CK-MB≥30 U/L,hs-cTnT≥0.5 ng/L,LVEF≤50%,LVEDD≥50 mm were risk factors for complications after PCI in patients with myocardial infarction(OR>1,P<0.05).Complete revascularization was a protective factor for complications after PCI in patients with myocardial infarction(OR=0.313,P<0.05).Conclusions Risk of complications after PCI in patients with myocardial infarction is high.Age,complications,abnormal heart rate and cardiac function index are the risk factors for complications after PCI in patients with myocardial infarction,and complete revascularization is the protective factor.

关 键 词：心肌梗死 血管成形术 经腔 经皮冠状动脉 并发症 长期随访 危险因素 

分 类 号：R542.22[医药卫生—心血管疾病]