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急性心肌梗死并发心源性休克的临床特征(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2008年第5期
页码:
596-598
栏目:
临床研究
出版日期:
2008-10-20

文章信息/Info

Title:
Clinical features of cardiogenic shock complicated by acute myocardial infarction
作者:
李静; 华琦
首都医科大学宣武医院心内科，北京 100053
Author(s):
LI Jing;  HUA Qi
Department of Cardiovasology, Xuanwu Hospital, Beijing 100053, China
关键词:
心肌梗死; 急性; 心源性休克
Keywords:
myocardial infarction;  acute;  cardiogenic shock
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
目的 分析急性心肌梗死并发心源性休克患者的临床特征。方法 连续收集我院1995年～2005年初发急性ST段抬高心肌梗死患者资料，按照是否有心源性休克分为两组。分析患者一般情况、化验指标、危险因素、并发症和病死率的差异。结果 休克组年龄显著高于非休克组［（70±9）岁 vs （63±12）岁，P<0.01］；两组间血清磷酸激酶同工酶（CK-MB）、WBC和电解质水平无显著差异；休克组吸烟者明显少于非休克组(19% vs 52％，P<0.01)，其他危险因素无显著差异；休克组心律失常和心脏破裂的发生率显著增高，病死率明显高于非休克组（83％ vs 8％，P<0.01）。结论 高龄是心肌梗死并发心源性休克的关键因素之一，心源性休克患者临床情况更为凶险，预后不良。
Abstract:
AIM To study the clinical features in patients with cardiogenic shock complicated by acute myocardial infarction. METHODS A total of 991 patients were divided into two groups by the presence or absence of cardiogenic shock. Data of the patients including general conditions, chemical examination, risk factors, complications and mortality were compared by statistical method. RESULTS The age of patients with cardiogenic shock was higher than that of the control \[(70±9)yr vs (63±12)yr, P<0.01)\]. Between the two groups, the level of MB isoenzyme of creatine kinase, white blood cell and electrolyte was similar. The amount of smokers in the shock group was lower (19.1% vs 516％, P<0.01) and other risk factors were similar. In the shock group, the incidence of arrhythmia and cardiac rupture were significantly higher than that of control group and the mortality was higher (83.0％ vs 8.5％, P<0.01). CONCLUSION Age is one of the critical factors of the occurrence of cardiogenic shock. Clinical conditions of patients with caridogenic shock are severer and prognosis is unfavorable.

参考文献/References

［1］ Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with STelevation myocardial infarctionexecutive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction)［J］. Circulation, 2004, 110(5):588-636.

［2］ Carnedran L, Abboud R, Sleeper LA, et al. Trends in cardiogenic shock; report from the SHOCK study［J］. Eur Heart J, 2001, 22(6):472-478.

［3］ Holmes D Jr. Cardiogenic SHOCK: a lethal complication of acute myocardial infarction［J］. Rev Cardiovasc Med, 2003, 4(3):131-135.

［4］ Kober L, TorpPedersen C, Ottesen M. Influence of age on the prognostic importance of left ventricular dysfunction and congestive heart failure on longterm survival after acute myocardial infarction［J］. Am J Cardiol, 1996, 78(2):158-162.

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［6］ Menon V, Webb JG, Hillis LD, et al. Outcome and profile of ventricular septal rupture with cardiogenic shock after myocardial infarction: a report from the SHOCK Trial Registry. Should we emergently revascularize Occluded Coronaries in cardiogenic shock?［J］. J Am Coll Cardiol, 2000, 36(3 Suppl A):1110-1116.

［7］ Webb JG, Sleeper LA, Buller CE, et al. Implications of the timing of onset of cardiogenic shock after acute myocardial infarction: a report from the SHOCK Trial Registry. Should we emergently revascularize Occluded Coronaries in cardiogenic shock?［J］. J Am Coll Cardiol, 2000, 36(3):1084-1090.

［8］ 赵玉生，王士雯，卢才义. 急性心肌梗死并发心源性休克的临床特征与救治［J］. 中国危重病急救医学， 2004， 16（3）：148-150.

［9］ White HD, Assmann SF, Sanborn TA, et al. Comparison of percutaneous coronary intervention and coronary artery bypass grafting after acute myocardial infarction complicated by cardiogenic shock: results from the Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) trial［J］. Circulation, 2005, 112(13):1992-2001.

［10］李桂琼,陈庆伟. 急性心肌梗死合并心源性休克的研究进展［J］. 心血管病学进展， 2005, 26（1）：99-102.

备注/Memo

备注/Memo:
收稿日期：2008-05-27.基金项目：北京市自然科学基金项目资助（7072032） 通讯作者：华琦，教授，主要从事高血压冠心病的研究 Email：huaqi5371@medmail.net
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