摘要
目的观察急性心肌梗死(AMI)合并心源性休克(CS)急诊冠状动脉(冠脉)再通后不同治疗方式对患者疗效和生存率的影响。方法回顾性分析开封市中心医院急诊重症监护病房(EICU)2016年1月至2020年12月收治的161例AMI-CS患者的临床资料。按不同诊疗方式将患者分为常规治疗组(46例)、左西孟旦组(50例)、主动脉内球囊反搏(IABP)组(37例)和IABP+左西孟旦组(28例)。比较不同治疗方式4组患者一般资料、入院时和治疗7 d的基础生命指标、床旁超声指标左室射血分数(LVEF)、左室收缩期末内径(LVESD)、左室舒张期末内径(LVEDD)、心指数(CI),以及实验室指标心肌肌钙蛋白I(cTnI)、N末端脑钠肽前体(NT-proBNP)、血乳酸(Lac)水平的差异。再将患者按预后分为存活组和死亡组,比较不同临床预后患者基础资料的差异。采用多重线性回归分析影响患者预后危险因素,并绘制受试者工作特征曲线(ROC曲线),评价各危险因素对患者预后的预测价值。结果治疗后4组患者心率(HR)、LVESD、LVEDD、cTnI、NT-proBNP、Lac均较治疗前降低,平均动脉压(MAP)、LVEF和CI均较治疗前升高。与常规治疗组比较,仅左西孟旦组MAP明显降低〔mmHg(1 mmHg≈0.133 kPa):73.30±3.83比76.06±4.31,P<0.05〕,IABP组、左西孟旦组和IABP+左西孟旦组LVEF和CI均升高,LVESD、LVEDD、Lac均降低,以IABP+左西孟旦组的变化更显著〔LVEF:0.4061±0.0508比0.3735±0.0260,CI(L·min^(-1)·m^(-2)):2.89±0.26比2.48±0.14,LVESD(mm):34.06±2.84比39.76±5.14,LVEDD(mm):60.61±3.74比70.00±5.13,Lac(mmol/L):2.43±0.54比3.10±1.47,均P<0.05〕。IABP+左西孟旦组和左西孟旦组病死率均较常规治疗组明显降低〔35.71%(10/28)、40.00%(20/50)比63.04%(29/46),均P<0.05〕。死亡组患者年龄较存活组明显增加(岁:66.17±9.79比57.98±8.06,P<0.05),cTnI、Lac均较存活组明显升高〔cTnI(μg/L):0.21±0.08比0.07±0.06,Lac(mmol/L):7.92±1.60比2.22±0.88,均P<0.05〕。多重线�
Objective To observe the effects of different treatment methods on the curative effect and survival rate of patients with acute myocardial infarction(AMI)complicated with cardiogenic shock(CS)after emergency coronary re-canalization.Methods The clinical data of 161 patients with AMI-CS admitted to the emergency intensive care unit(EICU)of Kaifeng Central Hospital from January 2016 to December 2020 were retrospectively analyzed.According to different treatment methods,the patients were divided into conventional treatment group(46 cases),Levosimendan group(50 cases),intra-aortic balloon pump(IABP)group(37 cases)and IABP+Levosimendan group(28 cases).The general data,basic vital indicators at admission and 7 days after treatment,bedside ultrasound indexes:including left ventricular ejection fraction(LVEF),left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD),cardiac index(CI)and laboratory indicators:the levels of cardiac troponin I(cTnI),N-terminal probrain natriuretic peptide(NT-proBNP)and blood lactate(Lac)were compared among the four groups of patients with different treatment methods.Then the patients were divided into a survival group and a death group according to the prognosis,and the differences in basic data of patients with different clinical prognoses were also compared.Multiple linear regression analysis was used to analyze the risk factors affecting the patients'prognosis,and the receiver operator characteristic curve(ROC curve)was drawn to evaluate the predictive value of each risk factor for the prognosis of patients.Results After treatment,the levels of heart rate(HR),LVESD,LVEDD,cTnI,NT-proBNP,and Lac were all decreased,and mean arterial pressure(MAP),LVEF and CI were increased compared with those before treatment in the patients of the fours groups.Compared with the conventional treatment group,only in the Levosimendan group was MAP lower significantly[mmHg(1mmHg≈0.133 kPa):73.30±3.83 vs.76.06±4.31,P<0.05],LVEF and CI were increased in the IABP group,Levos
作者
陈兰涛
吴田田
陈敬
陈秋丽
郑志刚
刘建中
段宝民
Chen Lantao;Wu Tiantian;Chen Jing;Chen Qiuli;Zheng Zhigang;Liu Jianzhong;Duan Baomin(Emergency Center of Kaifeng Central Hospital,Kaifeng 475000,Henan,China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2022年第5期529-534,共6页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
河南省开封市科技攻关项目(1903035)。
关键词
主动脉内球囊反搏
左西孟旦
急性心肌梗死
心源性休克
有效性
病死率
Intra-aortic balloon pump
Levosimendan
Aacute myocardial infarction
Cardiogenic shock
Effectiveness
Mortality
