摘要
目的:分析影响主动脉内球囊反搏(IABP)辅助的急性心肌梗死(AMI)合并心源性休克(CS)患者院内死亡的危险因素。方法:连续收录2005年1月至2016年12月,在北京安贞医院因AMI合并CS临床应用IABP的住院患者,共231例,比较死亡与存活患者入院一般情况、治疗及IABP应用情况等临床特点,以二分类Logistic回归分析导致院内死亡的危险因素。结果:院内死亡组较存活组年龄偏高,女性患者偏多,发生CS时血射血分数较低,CKMB及血乳酸肌酐较高。死亡组发生机械并发症及室性心动过速及心室颤动较多,且多支冠状动脉血管病变,未进行任何血运重建者较多。存活组急诊PCI者较多。二分类Logistic回归示,高龄(年龄>60岁)、中度及以上肾功能不全、高乳酸值(>2μmol/L)、低射血分数(<50%)及病变血管≥2支为导致CS患者院内死亡的危险因素。结论:AMI合并CS患者,尤其是基础状态差、冠状动脉病变重的患者,院内死亡风险极高。IABP作为桥梁,为患者维持血流动力学稳定及尽快血运重建等方面有着积极地意义。在IABP支持下进行及时血运重建,是挽救高危患者生命的关键。
Objective: To investigate clinical characteristics of AMI with CS patients support by IABP,and to evaluate risk factors of the in-hospital mortality support by IABP. Methods: The clinical data of consecutive 231 AMI with CS patients with the use of IABP selected from January 2005 to December 2016 were retrospectively analyzed. The research of clinical characteristics and risk factors of is compared in non-survivors and the survivors. Results: non-survivors group had more female and older patients,lower left ventricular ejection fraction( LVEF) and higher serum creatinine when cardiac shock. Mechanical complications,ventricular tachycardia and ventricular fibrillation were more seen in non-survivors group. More patients were treated with emergency reperfusion therapy( PTCA and PCI) in survival group. Binary logistic regression showed advanced age( older than 60 years old),moderate or above renal insufficiency,high lactate level( 2μmol/L),LVEF 50% and more than 2 vascular lesion were the independent risk factors of death in CS patients. Conclusion:patients with acute myocardial infarction complicating cardiac shock were in a high mortality rate,application of IABP support can provide basic life support,and can be more effective combined with revascularization. patients with poor LVEF、heavy coronary artery lesions and moderate or above renal insufficiency has high mortality,and IABP support is useful.
作者
陈凌霄
吕树铮
宋现涛
戴敬
田晋帆
崔孔勇
闫云峰
周阔
CHEN Lingxiao;LU Shuzheng;SONG Xiantao;DAI ring;TIAN Jifan;CUI Kongyong;YAN Yunfeng;ZHOU Kuo(Department of 1 th Ward, Belting Anzhen Hospital, Capital Medical Uni- versity, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China)
出处
《心肺血管病杂志》
2018年第4期294-297,共4页
Journal of Cardiovascular and Pulmonary Diseases
基金
心血管疾病精准医学北京实验室(PXM2017_014226_000037)
关键词
主动脉内球囊反搏
急性心肌梗死
心源性休克
Intra-aortic balloon pumping
Acute myocardial infarction
Cardiogenic shock