摘要
目的:评估主动脉内球囊反搏-休克Ⅱ(IABP-SHOCKⅡ)评分对急性心肌梗死(AMI)并发心源性休克(CS)患者30 d病死率的预测价值。方法:本研究为单中心回顾性队列研究。连续纳入2013年1月至2018年12月,在北京安贞医院收治的227例AMI并发CS且置入IABP的患者。根据IABP-SHOCKⅡ评分将患者分为低风险组(评分0~2分,132例)、中风险组(评分3~4分,55例)和高风险组(评分5~9分,40例),比较三组患者的基线资料、治疗和预后情况,Kaplan-Meier生存曲线和Log-rank检验分析三组的随访30 d的病死率差异,受试者工作特征(ROC)曲线评估IABP-SHOCKⅡ评分对AMI并发CS患者30 d病死率的预测价值。结果:227例患者中,男性125例(55.1%),平均年龄为(58.7±17.2)岁。三组的年龄、是否患有糖尿病、肌钙蛋白I、肌酸激酶-心肌型、NF-proBNP、血肌酐、乳酸、LVEF、LVESD、LVEDD等均差异有统计学意义(均为P<0.05)。此外,三组的冠状动脉Gensini评分、TIMI血流<3级、无创机械通气、有创机械通气、连续肾脏替代治疗和体外膜肺氧合应用率等均明显差异(均为P<0.05)。随访30 d,低风险组(20.5%)、中风险组(41.8%)和高风险组(82.5%)的病死率有明显差异(P<0.001),且高风险和中风险组的死亡率明显高于低风险组(均为P<0.05),而高风险组的死亡率也明显高于中风险组(P<0.001)。ROC曲线显示IABP-SHOCKⅡ评分预测30 d死亡的敏感度为82.4%,特异度为83.1%,曲线下面积为0.811(95%CI:0.714~0.921,P=0.001)。结论:IABP-SHOCKⅡ≥5分的高风险患者预后差,IABP-SHOCKⅡ评分可用于国人AMI并发CS患者的危险分层。
Objective:To evaluate the predictive value of intra-aortic balloon counter pulsation-shockⅡ(IABP-SHOCKⅡ)score for 30-day mortality in patients with cardiogenic shock(CS)after acute myocar-dial infarction(AMI).Methods:This was a single-center retrospective cohort study.227 patients with CS after AMI admitted to our hospital from January 2013 to December 2018 with IABP were enrolled.According to the IABP-SHOCKⅡscore,they were divided into low-risk group(score 0 to 2 points,n=132),middlerisk group(3 to 4 points,n=55)and high-risk group(scores 5 to 9 points,n=40).Baseline data,drug and interventional therapy,and prognosis were compared among the three groups.The Kaplan-Meier survival analysis curve was used to evaluate the rate of mortality,and the receiver operating characteristic(ROC)curve to evaluate the predictive value of IABP-SHOCKⅡfor 30-day mortality.Results:Of the 227 patients,125(55.1%)were male,with an average age of(58.7±17.2)years.There were significant differences in age,cardiac troponin I,N-terminal B-type pro-natriuretic peptide,lactic acid,Gensini score,the rate of TIMI<3,the usage rate of noninvasive,invasive ventilation,continuous renal replacement therapy and extracorporeal membrane oxygenation in the intermediate-risk and highrisk groups compared with the low-risk group(all P<0.05).After 30 days of follow-up,the rate of mortality was significantly different among the low-,intermediate,and high-risk groups(P<0.001).The mortality rates of the high-and intermediate-risk groups were significantly higher than that of the low-risk group(both P<0.05),and the mortality rate of the high-risk group was also significantly higher than that of the intermediate-risk group(P<0.001).The ROC curve showed that the sensitivity of the IABP-SHOCKⅡscore for predicting 30-day mortality was 82.4%,the specificity was 83.1%,and the area under the curve was 0.811(95%CI:0.714-0.921,P=0.001).Conclusions:Patients with IABP-SHOCKⅡscore≥5 are associated with poor prognosis,and IABP-SHOCKⅡscore could be used for risk stratification in chinese patients with CS after AMI.
作者
屈超
李响
蒲连美
刘飞
齐疏影
张晶
QU Chao;LI Xiang;PU Lianmei;LIU Fei;QI Shuying;ZHANG Jing(Department of Emergency and Critical Care Center,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)
出处
《心肺血管病杂志》
2020年第12期1429-1434,共6页
Journal of Cardiovascular and Pulmonary Diseases
基金
国自然面上项目(81672151)。
