| 周陈琛,钟文婷,刘 巍,王 雪,范羽飞.主动脉内球囊反搏术对行经皮冠状动脉介入术AMI合并CS患者的影响及术后院内死亡的危险因素分析[J].,2023,(1):58-63 |
| 主动脉内球囊反搏术对行经皮冠状动脉介入术AMI合并CS患者的影响及术后院内死亡的危险因素分析 |
| Effect of Intra Aortic Balloon Counterpulsation on Patients with AMI Complicated with CS Undergoing Percutaneous Coronary Intervention and Analysis of Risk Factors of Postoperative in-Hospital Death |
| 投稿时间：2022-05-30 修订日期：2022-06-24 |
| DOI：10.13241/j.cnki.pmb.2023.01.011 |
| 中文关键词: 急性心肌梗死 心源性休克 主动脉内球囊反搏术 经皮冠状动脉介入术 死亡 危险因素 |
| 英文关键词: Acute myocardial infarction Cardiogenic shock Intra aortic balloon counterpulsation Percutaneous coronary intervention Death Risk factors |
| 基金项目:江苏省科技发展计划项目（BL1812071） |
|
| 摘要点击次数: 524 |
| 全文下载次数: 310 |
| 中文摘要: |
| 摘要 目的：分析主动脉内球囊反搏术（IABP）对行经皮冠状动脉介入术（PCI）急性心肌梗死（AMI）合并心源性休克（CS）患者的影响及术后院内死亡的危险因素。方法：选取2020年6月-2022年5月我院收治的105例AMI合并CS患者，将直接行PCI治疗患者设为对照组（n=59例），行IABP辅助支持下PCI治疗患者设为研究组（n=46例）。比较两组术后心脏指标[左室射血分数（LVEF）、左室舒张末期内径（LVEDD）和左室收缩末期内径（LVESD）]、心肌酶谱指标[心肌肌钙蛋白T与肌钙蛋白I、肌酸激酶同工酶（CK-MB）]、术后主要心血管不良事件。根据患者出院时是否存活分为存活组（n=74）与死亡组（n=31），比较两组临床资料，采用多因素Logistic回归模型分析患者院内死亡的危险因素。结果：术后两组LVEF较术前提高，LVEDD、LVESD降低，且研究组LVEF高于对照组，LVEDD、LVESD低于对照组（P＜0.05）。术后两组心肌酶谱指标较术前显著下降，且研究组肌钙蛋白I、肌钙蛋白T、CK-MB水平低于对照组（P＜0.05）。术后对照组发生5例再发心肌梗死、7例急性血栓形成，研究组分别为2例、3例（P＞0.05）；对照组死亡23例，研究组死亡8例，研究组死亡人数低于对照组（P＜0.05）。死亡组年龄、Killip分级≥Ⅲ级、高血脂、LVEF＜40%、TIMI血流分级≤Ⅱ级占比、白细胞计数、血肌酐水平高于存活组，收缩压、舒张压、血红蛋白、肌钙蛋白I、肌钙蛋白T、CK-MB、LVEF、IABP辅助低于存活组（P＜0.05）。多因素Logistic回归分析显示，年龄≥65岁、Killip分级≥Ⅲ级、LVEF＜40%、TIMI血流分级≤Ⅱ级为患者院内死亡的危险因素（P＜0.05）。结论：IABP辅助支持下的PCI能有效改善AMI合并CS患者心功能，年龄≥65岁、Killip分级≥Ⅲ级、LVEF＜40%、TIMI血流分级≤Ⅱ级为等为其院内死亡危险因素。 |
| 英文摘要: |
| ABSTRACT Objective: To analyze the effect of intra aortic balloon counterpulsation (IABP) on patients with acute myocardial infarction (AMI) complicated with ardiogenic shock (CS) undergoing percutaneous coronary intervention (PCI) and the risk factors of postoperative in-hospital death. Methods: 105 patients with AMI complicated with CS who were treated in our hospital from June 2020 to May 2022 were selected. The patients treated with PCI directly were set as the control group (n=59 cases), and the patients treated with PCI assisted by IABP were set as the study group (n=46 cases). The postoperative cardiac indexes [left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD) and left ventricular end systolic diameter (LVESD)], myocardial zymogram indexes [cardiac troponin T and troponin I, creatine kinase isoenzyme (CK-MB)] and postoperative major cardiovascular adverse events were compared between the two groups. The patients were divided into survival group(n=74) and death group (n=31)according to whether they survived at discharge. The clinical data of the two groups were compared, and the risk factors of in-hospital death were analyzed by multivariate logistic regression model. Results: The LVEF of the two groups after operation was increased, LVEDD and LVESD were decreased, and LVEF of the study group was higher than that of the control group, and LVEDD and LVESD were lower than those of the control group (P＜0.05). The myocardial zymogram indexes of the two groups after operation were significantly decreased compared with those before operation, and the levels of troponin I, troponin T and CK-MB of the study group were lower than those of the control group (P＜0.05). There were 5 cases of recurrent myocardial infarction and 7 cases of acute thrombosis of the control group after operation, 2 cases and 3 cases of the study group respectively (P＞0.05). There were 23 deaths of the control group, and 8 deaths of the study group. The number of deaths of the study group was lower than that of the control group (P＜0.05). The age, Killip grade ≥ grade III, hyperlipidemia, LVEF ＜ 40%, proportion of TIMI blood flow grade ≤ grade II, leukocyte count and serum creatinine level of the death group were higher than those of the survival group, and systolic blood pressure, diastolic blood pressure, hemoglobin, troponin I, troponin T, CK-MB, LVEF and IABP assisted were lower than those in the survival group (P＜0.05). Multivariate logistic regression analysis showed that age ≥ 65 years, Killip grade ≥ grade III, LVEF < 40% and TIMI blood flow grade ≤ grade II were the risk factors for in-hospital death of patients(P＜0.05). Conclusion: IABP assisted supported PCI can effectively improve cardiac function in patients with AMI complicated with CS. Age ≥ 65 years, Killip grade ≥ grade III, LVEF <40%, TIMI blood flow grade ≤ grade II are the risk factors for in-hospital death. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
