急性心肌梗死合并心原性休克患者器械辅助支持下直接经皮冠状动脉介入治疗预后不良的因素分析  

Factors of prognosis of patients with acute myocardial infarction complicated with cardiogenic shock undergoing primary percutaneous coronary intervention under the support of mechanical devices

作　　者：罗明华[1] 陈玉善[1] 王贺[1] 关怀敏[1] 解金红[1] 邱承杰[1] 宗永华 尚莎莎 王运蔚 LUO Ming-hua;CHEN Yu-shan;WANG He;GUAN Huai-min;XIE Jin-hong;QIU Cheng-jie;ZONG Yong-hua;SHANG Sha-sha;WANG Yun-wei(Department of Cardiology,the First Affi liated Hospital of Henan University of Chinese Medicine,Heart Center/National Regional(Traditional Chinese Medicine)Cardiovascular Diagnosis and Treatment Center,Zhengzhou 450000,China)

机构地区：[1]河南中医药大学第一附属医院心脏中心/国家区域(中医)心血管诊疗中心,河南郑州450000

出　　处：《中国介入心脏病学杂志》2024年第4期197-202,共6页Chinese Journal of Interventional Cardiology

基　　金：国家自然科学基金项目(82274316)。

摘　　要：目的本研究旨在考察急性心肌梗死合并心原性休克患者直接经皮冠状动脉介入治疗(PPCI)术后预后不良的影响因素。方法入选2015年1月至2019年12月期间,河南中医药大学第一附属医院胸痛中心收治急性心肌梗死合并心原性休克并且行PPCI的患者,收集其临床基线特征、冠状动脉造影及PPCI相关参数、器械辅助支持信息等。根据1年内随访生存与否,分为生存组与死亡组,比较两组各项因素。结果共入选40例患者,其中生存组26例,死亡组14例。两组在基线资料、入院诊断、危险因素及合并症等方面差异均无统计学意义(均P>0.05);生存组较死亡组有入院时心率较低、血压较高的趋势;生存组心肌酶显著低于死亡组(肌酸激酶峰值:496.00(198.25,2830.00)U/L比3040.00(405.75,5626.53)U/L,P=0.003;肌酸激酶同工酶MB型峰值:52.65(31.75,219.50)U/L比306.00(27.25,489.63)U/L,P=0.006);两组间在冠状动脉造影及PPCI相关指标方面比较,生存组较对照组有更高的完全血运重建率(53.85%比21.43%,P=0.048);两组器械辅助支持方面比较,生存组较死亡组有更多的体外膜肺氧合(ECMO)联合主动脉内球囊反搏(IABP)支持的比例(38.46%比7.14%,P=0.034)。结论急性心肌梗死合并心原性休克行PPCI的患者的预后与心肌酶水平、ECMO联合IABP支持以及完全血运重建有关。Objective To investigate the factors infl uencing prognosis in patients with acute myocardial infarction complicated with cardiogenic shock undergoing primary percutaneous coronary intervention(PPCI).Methods Patients with acute myocardial infarction complicated with cardiogenic shock who underwent PPCI at our hospital between January 2015 and December 2019 were enrolled.Clinical baseline characteristics,coronary angiography and PCI-related parameters,and mechanical support information were collected.The patients were followed up for one year and divided into survival and death groups based on their survival status within one year.Diff erences in various factors between the two groups were compared.Results A total of 40 patients were enrolled,including 26 in the survival group and 14 in the death group.There were no differences in baseline data,diagnosis,risk factors,and comorbidities between the two groups.The survival group had a lower heart rate and higher blood pressure trend at admission compared to the death group.Myocardial enzymes were signifi cantly lower in the survival group compared to the death group(median CK peak:496.00(198.25,2830.00)U/L vs.3040.00(405.75,5626.53)U/L,P=0.003;median CK-MB peak:52.65(31.75,219.50)U/L vs.306.00(27.25,489.63)U/L,P=0.006).When comparing coronary angiography and PCI-related indicators between the two groups,the survival group had a higher rate of complete revascularization compared to the control group(53.85%vs.21.43%,P=0.048).The survival group had a higher proportion of extracorporeal membrane oxygenation(ECMO)combined with intra�aortic balloon pump(IABP)support compared to the control group[38.46%vs.7.14%,P=0.034].Conclusions Survival in patients with acute myocardial infarction complicated with cardiogenic shock undergoing PPCI is associated with lower level of myocardial enzymes,ECMO combined with IABP support and complete revascularization.

关 键 词：急性心肌梗死 心原性休克 预后 直接经皮冠状动脉介入治疗 心肌酶 体外膜肺氧合 主动脉内球囊反搏 

分 类 号：R54[医药卫生—心血管疾病]