摘要
目的 探讨急性前壁ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入术(PCI术后发生心源性休克危险因素。方法 纳入2015年1月至2019年9月间于武汉大学人民医院心内科行急诊PCI的急性前壁STEMI患者(n=390),按术后是否发生心源性休克,分为休克组(n=69)和非休克组(n=321),收集住院电子病历信息。比较两组一般资料、药物及手术治疗相关指标。结果 休克组年龄、白细胞、中性粒细胞计数、血肌酐(Scr)、超敏C反应蛋白(hs-CRP)及心肌总缺血时间均高于非休克组(P<0.05)。休克组女性、并发心房颤动、恶性心律失常(室性心动过速、心室颤动)及术后TIMI血流<3级所占比例均显著高于非休克组(P<0.05)。多因素Logistic回归分析提示Scr、hs-CRP、并发心房颤动及恶性心律失常是急性前壁STEMI患者急诊PCI术后发生心源性休克的独立危险因素(P<0.05)。结论 急性前壁STEMI患者的Scr、hs-CRP,并发心房颤动或恶性心律失常是急诊PCI术后发生心源性休克的独立危险因素,应当在早期识别这类高危患者并及时调整诊疗策略。
Objective To investigate the risk factors of cardiogenic shock(CS) in patients with acute anterior ST-segment elevation myocardial infarction(STEMI) after primary percutaneous coronary intervention(PCI).Methods The patients with acute anterior STEMI(n=390) undergone primary PCI were chosen from Department of Cardiology in Renmin Hospital of Wuhan University from Jan.2015 to Sept.2019,and divided,according to whether or not CS incidence after PCI,into CS group(n=69) and non-CS group(n=321).The data of hospitalization electronic medical record(EMR) was collected,and general materials,medicines and indexes related to operation treatment were compared between 2 groups.Results The age,white blood cell count(WBC),neutrophil count(Neu),serum creatinine(Scr),high sensitivity C-reactive protein(hs-CRP) and the total myocardial ischemia time were all higher in CS group than those in non-CS group(P<0.05).The percentages of female cases and patients with complicated atrial fibrillation(AF),malignant arrhythmia(ventricular tachycardia,ventricular fibrillation)and postoperative TIMI blood flow<grade 3 were all higher in CS group than those in non-CS group(P<0.05).The results of Logistic regression analysis showed that Scr,hs-CRP,and complicated AF and malignant arrhythmia were independent risk factors of CS in patients with acute anterior STEMI after primary PCI(P<0.05).Conclusion In patients with acute anterior STEMI,Scr,hs-CRP,and complicated AF and malignant arrhythmia are independent risk factors of CS after PCI.Those high-risk patients should be identified early and diagnosis and treatment strategies should be adjusted for them in time.
作者
金星
陈静
黄兵
刘根
王贇
柳小佩
陈祥洲
胡莹莹
胡正
孙嘉欣
张博方
胡琦
Jin Xing;Chen Jing;Huang Bing;Liu Gen;Wang Yun;Liu Xiaopei;Chen Xiangzhou;Hu Yingying;Hu Zheng;Sun Jiaxin;Zhang Bofang;Hu Qi(Department of Cardiovascular Medicine,Renmin Hospital of Wuhan University,Wuhan 430060,China;不详)
出处
《中国循证心血管医学杂志》
2022年第4期417-419,426,共4页
Chinese Journal of Evidence-Based Cardiovascular Medicine
基金
国家自然科学基金(81570331)
湖北省自然科学基金(2018CFB240)。
关键词
前壁ST段抬高型心肌梗死
急诊经皮冠状动脉介入治疗
心源性休克
危险因素
Anterior ST-segment elevation myocardial infarction
Primary percutaneous coronary intervention
Cardiogenic shock
Risk factors
