摘要
目的:对主动脉内球囊反搏(IABP)辅助的急性心肌梗死(AMI)患者的院内死亡及生存的比较,分析影响IABP辅助的急性心肌梗死患者院内死亡的危险因素。方法:连续收录本院心内科2005年7月至2013年7月间,发病在72h之内并应用IABP辅助治疗的急性心肌梗死患者572例,其中发生院内死亡患者81例。比较死亡与存活患者入院一般情况、介入治疗情况及IABP辅助情况等临床特点,以二分类Logistic回归分析导致院内死亡的独立危险因素。结果:与院内生存组相比,院内死亡组年龄较高,女性患者多,Killip III^IV级患者多;患者发病至入院时间较长,入院时心率较快,血压较低,血肌酐较高,左心室射血分数较低,合并高血压及糖尿病的比例更高,犯罪血管为左主干及多支血管病者较多。二分类Logistic回归分析显示:高龄(年龄>65岁)(OR=2.224,95%CI:1.106~4.475,P=0.025)、发病至入院时间长(OR=1.021,95%CI:1.005~1.038,P=0.012)、心功能Killip分级III^IV(OR=11.167,95%CI:3.895~32.019,P<0.001)、中度以上肾功能不全(OR=2.497,95%CI:1.325~4.705,P<0.01)及左心室射血分数降低(OR=1.060,95%CI:1.035~1.086,P<0.01)为导致院内死亡的独立危险因素。结论:IABP辅助可以改善急性心肌梗死患者的生命体征,为下一步治疗提供机会;但对于高危患者,包括老年、就诊时间延迟、心功能差及严重肾功能不全的患者,IABP辅助收效甚微,院内病死率高。
Objective： To investigate the incidence and risk factors of in-hospital death with IABP support in AMI patients. Methods： The clinical data of consecutive 572 AMI patients with the use of IABP selected from July 2005 to July 2013 were retrospectively analyzed. All patients＇ symptom onset to admission was within 72 hours. The evolution of the risk factors of in-hospital death and clinical characteristics was compared in 81 non-survivors and the survivors. Results： Non-survivors had a more severe clinical profile at admission,including an advanced age,significantly higher heart rate,lower blood pressures,a longer time to treatment,signs of heart failure（ Killip≥3）,higherbloodserum creatinine and a more often impaired left ventricular ejection fraction（ LVEF）. Higher prevalence of hypertension and diabetes mellitus was shown in the non-survivors.Left main coronary artery disease andmultivessels disease were frequently observed in non-survivorsgroup. More decedents＇ IABP support duration was ≤ 12 hours or ≥ 6 days,and less patients＇ IABP support duration was12 hours to 5 days. More patients died within 24 hours from hospital admission. Less non-survivors＇ hospitalization duration was longer than 8 days. Multivariate logistic regression analysis showed. Conclusion： IABP may have hemodynamic support to AMI patients for further intensive therapy,but IABP cannot improve the circulatory collapse status for patients who have advanced age,prolonged time from symptom onset to first medical contact,severe decompensated heart failure and renal failureand are associated with higher in-hospital mortality.
出处
《心肺血管病杂志》
2016年第3期175-179,共5页
Journal of Cardiovascular and Pulmonary Diseases
关键词
主动脉内球囊反搏
急性心肌梗死
院内死亡
危险因素
Intra-aortic balloon pump
Acute Myocardial Infarction
In-hospital mortality
Risk facors
