摘要
目的探讨影响急性心肌梗死(AMI)合并心原性休克(CS)患者住院期间死亡的因素。方法回顾性分析2002年4月至2019年4月于首都医科大学附属北京朝阳医院心脏中心接受治疗的321例AMI合并CS患者的临床资料。将患者分为院内死亡组(230例)和院内生存组(91例)。比较两组患者的基线特征、冠状动脉造影和介入治疗特征、心功能和生化指标。结果与院内生存组相比,院内死亡组患者年龄偏大,院前时间偏长,非ST段抬高型心肌梗死比例偏高;三支冠状动脉病变发生率高,实施心肺复苏比例高,急诊经皮冠状动脉介入治疗(PCI)率偏低;血清肌酐和B型脑钠肽显著增高。两组主动脉内球囊反搏(IABP)置入率相当(82.3%比86.8%,P=0.349)。两组左心室射血分数、肌钙蛋白I峰值、低密度脂蛋白胆固醇、白细胞计数、红细胞沉降率和C反应蛋白比较,差异均无统计学意义(均P>0.05)。logistic多因素回归分析显示,年龄(OR 1.005,95%CI 0.992~1.212,P=0.047)、院前时间(OR 0.898,95%CI 0.991~1.006,P=0.048)、急诊PCI(OR 0.331,95%CI 0.103~3.521,P=0.039)和实施心肺复苏(OR 7.238,95%CI 1.620~32.343,P=0.010)是AMI合并CS住院期间死亡的独立预测因素。结论IABP置入不影响AMI合并CS住院期间生存率。年龄、院前时间、急诊PCI和实施心肺复苏是住院期间死亡的独立预测因素。
Objective To investigate the factors those aff ect the in-hospital mortality of patients with acute myocardial infarction(AMI)combined with cardiogenic shock(CS).Methods The clinical data of 321 cases of patients with AMI combined with CS admitted to Heart Center of Beijing Chaoyang Hospital,Capital Medical University from April 2002 to April 2019 was analyzed retrospectively.The patients were divided into survival group(n=91)and death group(n=230).The baseline characteristics,coronary angiography and primary percutaneous coronary intervention(PCI),heart function and biochemical indexes were compared between the two groups.Results Compared with the survival group,the patients in the death group were older with longer pre-hospital duration and the higher proportion of NSTEMI;the incidence of three vessels disease and the cardiopulmonary resuscitation(CPR)rate was higher and rate of primary PCI was lower.The serum creatinine and B-type natriuretic peptide signifi cantly increased in the death group.The implantation of intra-aortic balloon pump(IABP)in the two groups was comparable(82.3%vs.86.8%,P=0.349).There were no statistically significant differences of left ventricular ejection fraction,peak value of cardiac troponin I,low density lipoprotein-cholesterin,white blood cell count,erythrocyte sedimentation rate,C-reactive protein between the two groups(all P>0.05).Multivariable logistic analysis showed that age(OR 1.005,95%CI 0.992-1.212,P=0.047),pre-hospital duration(OR 0.898,95%CI 0.991-1.006,P=0.048),primary PCI(OR 0.331,95%CI 0.103-3.521,P=0.039)and cardiopulmonary cerebral resuscitation(OR 7.238,95%CI 1.620-32.343,P=0.010)were independent predictors of in-hospital death.Conclusions IABP implantation did not aff ect the survival rate during hospitalization for patients with AMI combined with CS.Age,pre-hospital duration,primary PCI and cardiopulmonary cerebral resuscitation were independent predictors of death during hospitalization.
作者
刘宇
丰德京
王乐丰
李奎宝
王洪江
杨新春
王红石
徐立
夏昆
倪祝华
李惟铭
张大鹏
何冀芳
孙昊
郭宗生
张智勇
姜锋
钟久昌
卢燕
张英
LIU Yu;FENG De-jing;WANG Le-feng;LI Kui-bao;WANG Hong-jiang;YANG Xin-chun;WANG Hong-shi;XU Li;XIA Kun;NI Zhu-hua;LI Wei-ming;ZHANG Da-peng;HE Ji-fang;SUN Hao;GUO Zong-sheng;ZHANG Zhi-yong;JIANG Feng;ZHONG Jiu-chang;LU Yan;ZHANG Ying(Department of Heart Center,Beijing Key Laboratory of Hypertension,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)
出处
《中国介入心脏病学杂志》
2020年第4期181-186,共6页
Chinese Journal of Interventional Cardiology
基金
北京市医院管理中心消化内科学科协同发展中心消化专项重点项目子课题(XXZ0607)。
关键词
急性心肌梗死
心原性休克
主动脉内球囊反搏
Acute myocardial infarction
Cardiogenic shock
Intra-aortic balloon pump
