王磊, 张晓辉, 张越, 曹威. 急性心肌梗死合并心源性休克患者急诊PCI术后院内死亡的危险因素[J]. 职业卫生与应急救援, 2020, 38(1): 15-19, 40. DOI: 10.16369/j.oher.issn.1007-1326.2020.01.004
引用本文: 王磊, 张晓辉, 张越, 曹威. 急性心肌梗死合并心源性休克患者急诊PCI术后院内死亡的危险因素[J]. 职业卫生与应急救援, 2020, 38(1): 15-19, 40. DOI: 10.16369/j.oher.issn.1007-1326.2020.01.004
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WANG Lei, ZHANG Xiaohui, ZHANG Yue, CAO Wei. Risk factors for in-hospital death after primary PCI of patients with acute myocardial infarction and combined with cardiogenic shock[J]. Occupational Health and Emergency Rescue, 2020, 38(1): 15-19, 40. DOI: 10.16369/j.oher.issn.1007-1326.2020.01.004
Citation: WANG Lei, ZHANG Xiaohui, ZHANG Yue, CAO Wei. Risk factors for in-hospital death after primary PCI of patients with acute myocardial infarction and combined with cardiogenic shock[J]. Occupational Health and Emergency Rescue, 2020, 38(1): 15-19, 40. DOI: 10.16369/j.oher.issn.1007-1326.2020.01.004
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急性心肌梗死合并心源性休克患者急诊PCI术后院内死亡的危险因素

Risk factors for in-hospital death after primary PCI of patients with acute myocardial infarction and combined with cardiogenic shock

    摘要
  • 摘要:
    目的 探讨急性心肌梗死（acute myocardial infarction，AMI）合并心源性休克（cardiogenic shock，CS）患者行急诊经皮冠状动脉介入术（percutaneous coronary intervention，PCI）后发生院内死亡的危险因素。
    方法 回顾性分析98例行急诊PCI治疗的AMI合并CS患者临床资料。98例患者依据院内转归情况分为院内死亡组28例、存活组70例，比较2组临床资料、实验室检测数据、心肌梗死病变范围、治疗方法及并发症情况，用多因素logistic回归分析AMI合并CS患者急诊PCI后院内死亡的危险因素。
    结果 单因素分析结果显示，院内死亡组年龄、休克指数、白细胞计数、血肌酐水平及高脂血症、前壁心肌梗死、冠状动脉三支病变、IABP辅助比率及急性肾损伤、消化道出血发生率高于存活组（P < 0.05），血红蛋白、左室射血分数（left ventricular ejection fraction，LVEF）、PCI后TIMI血流分级Ⅲ级比率低于存活组（P < 0.05）；2组罪犯血管分布、应用血管活性药物比率，心律失常、心力衰竭、急性肝损伤、肺部感染发生率比较，差异均无统计学意义（P>0.05）。多因素logistic回归分析结果显示，分别以 < 65岁、LVEF ≥ 35%、后壁心肌梗死、PCI后TIMI血流Ⅲ级、无急性肾损伤、冠状动脉单支病变、无消化道出血为参照，年龄>75岁（OR=4.71）、LVEF < 35%（OR=5.53）、前壁心肌梗死（OR=1.86）、术后TIMI血流 < Ⅲ级（OR=7.10）、急性肾损伤（OR=2.97）、冠状动脉三支病变（OR=5.81）、消化道出血（OR=2.08）是急性心肌梗死合并心源性休克患者行急诊经皮冠状动脉介入术后发生院内死亡的危险因素。
    结论 在对患者施行PCI术前，应针对院内死亡的危险因素对病情评估综合，采取个体化治疗方案，必要时联合多种辅助治疗，减少、消除可引起死亡的危险因素，以提高PCI疗效。

     

    Abstract:
    Objective To understand the risk factors for in-hospital death of patients suffering with acute myocardial infarction(AMI) complicated with cardiogenic shock (CS) after they were treated by emergency percutaneous coronary intervention(PCI).
    Methods The clinical data of 98 patients, including 28 death cases and 70 alive cases, were retrospectively analyzed. The data of clinical characteristics, laboratory examination, myocardial infarction lesions, the treatment and the occurrence of complicated diseases were compared between the death and alive groups. Multivariate logistic regression analysis was performed to analyze the risk factors for in-hospital death of patients with AMI and CS after primary PCI.
    Results Univariate analysis showed that the age, the shock index, the white blood cell count, the serum creatinine level and occurrence of hyperlipidemia, IABP-assisted ratio, and the occurrence of anterior myocardial infarction, coronary artery disease, acute kidney injury, and gastrointestinal bleeding in the in-hospital death group were higher than that in the survival group (P < 0.05), while the hemoglobin, left ventricular ejection fraction (LVEF), and TIMI blood flow grade III ratio after emergency PCI were lower than that in the survival group (P < 0.05). There was no significant difference of the distribution of culprit vessels, the ratio of treatment with vasoactive drugs, and occurrence of arrhythmia, heart failure, acute liver injury and lung infection in the two groups(P>0.05). Multivariate logistic regression analysis showed major risk factors included the senior (age >75 years old, OR=4.71), the lower LVEF (< 35%, OR=5.53), the occurrence of anterior myocardial infarction (OR=1.86), the lower postoperative TIMI blood flow (< III, OR=7.10), the occurrence of acute kidney injury (OR=2.97), the occurrence of coronary artery disease (OR=5.81), and the occurrence of gastrointestinal bleeding (OR=2.08).
    Conclusion Before emergency PCI, the patients suffering with AMI complicated with CS should receive individualized treatment plus multiple adjuvant therapies, based on the comprehensive assessment of the patients' condition, specifically focusing on risk factors for in-hospital death mentioned above. Therefore, the risk factors of death will be reduced or eliminated, and the efficacy of emergency PCI can be improved.

     

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