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急性心肌梗死急诊经皮冠状动脉介入治疗患者院内死亡因素分析

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2014年第6期
页码:
662-665
栏目:
临床研究
出版日期:
2014-06-25

文章信息/Info

Title:
Analysis of in-hospital death in acute myocardial infarction patients treated with emergency percutaneous coronary intervention
作者:
任 晖1; 2; 黄立勋1; 庄贵华1; 巩 洁2; 李 静2; 祝 鹏2; 王甲文2
(1.西安交通大学医学部公共卫生学院，陕西 西安 710061；
2.安康市中心医院心血管内科，陕西 安康 725000)
Author(s):
REN Hui1; 2;  HUANG Li-xun1;  ZHUANG Gui-hua1;  GONG Jie2;  LI Jing1;  ZHU Peng1;  WANG Jia-wen1
(1.School of Public Health, College of Medicine, Xi’an Jiaotong University, Xi’an 710061, Shaanxi, China;
2.Department of Cardiology, Ankang Central Hospital, Ankang 725000, Shaanxi, China)
关键词:
冠状动脉疾病; 血管成形术; 经腔; 经皮冠状动脉; 死亡
Keywords:
coronary artery disease;  angioplasty;  transluminal;  percutaneous coronary;  prognosis;  death
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
目的:分析急性心肌梗死(AMI)患者行急诊经皮冠状动脉介入治疗（PCI）手术住院期间死亡的危险因素及死亡原因。方法： 438例接受急诊PCI的AMI患者，根据住院期间存活与否，分为死亡组(21例)和存活组(417例)，比较两组患者的临床特征和冠状动脉造影及介入治疗结果，分析发生院内死亡的原因及死亡预测因素。结果： 死亡组患者中年龄>65岁、心功能Killp分级≥Ⅱ级、心源性休克、广泛前壁梗死、多支闭塞（≥2支）、近段闭塞、梗死相关动脉（IRA）开通后即刻TIMI血流≤Ⅱ级、IRA开通后即刻血压下降与存活组相比较差异有统计学意义(均P<0.05)。多因素logistic回归分析表明年龄>65岁、心功能Killp分级≥Ⅱ级、心源性休克、广泛前壁梗死、IRA开通后即刻TIMI血流≤Ⅱ级是急诊PCI患者围术期死亡的独立预测因素。死亡原因中,心源性休克8例（38.1%）、恶性心律失常6例（28.6%）分居第1和第2位。结论： 年龄>65岁、心功能Killp分级≥Ⅱ级、心源性休克、广泛前壁梗死、IRA开通后即刻TIMI血流≤Ⅱ级是急诊PCI患者围术期死亡的危险因素。心源性休克、恶性心律失常是急诊PCI手术住院期间主要死亡原因。
Abstract:
AIM:To analyze the risk and death-causing factors of in-hospital death in acute myocardial infarction patients treated with emergency percutaneous coronary intervention (PCI). METHODS: Four hundred and thirty-eight AMI patients treated with emergency PCI were divided into death group (21 cases) and survival group (417 cases). Clinical features, coronary arteriography and intervention treatment results of the two groups were compared and the risk and death-causing factors of in-hospital death were analyzed. RESULTS: In death group, the rates of patients >65 years old, cardiac function with Killip class II or higher, cardiogenic shock, extensive anterior wall infarction, multiple branch occlusion (≥2), proximal occlusion, IRA opening immediately TIMI flow grade II or less and decrease of blood pressure were significantly different from those in the survival group (P<0.05). Multivariate logistic regression analysis showed that age >65 years old, cardiac function Killip class II or higher, cardiogenic shock, extensive anterior wall infarction, and IRA opening immediately TIMI flow grade II or less were independent predictors of death in emergency PCI patients. Cardiogenic shock (eight cases, 38.1%) and malignant arrhythmia (six cases, 28.6%) were the first and second leading causes of death. CONCLUSION: In patients >65 years, cardiac functional grading of Killip II or higher, cardiogenic shock, extensive anterior wall infarction, and IRA opening TIMI flow grade II or less are the perioperative risk factors for death in patients treated with emergency PCI. Cardiogenic shock and malignant arrhythmia are the main causes of death in emergency PCI surgical patients during hospitalization.

参考文献/References

[1]Keeley EC,Boura JA,Grines CL.Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials[J].Lancet,2003,361(9351):13-20.
[2]King SB,Smith SC,Hirshfeld JW,et al.2007 focused update of the ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice guidelines[J].J Am Coll Cardiol,2008,51(2):172-209.
[3]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2010,38(8):675-690.
[4]Halkin A,Singh M,Nikolsky E,et al.Prediction of mortality after primary percutaneous coronary intervention for acute myocardial infarction: the Cadillac risk score[J].J Am Coll Cardiol,2005,45(9):1397-1405.
[5]曹艳君,张红雨,吴志国,等.急诊经皮冠状动脉介入治疗急性心肌梗死围术期死亡因素分析[J].中华老年医学杂志,2011,30(9):726-728.
[6]韩雅玲,王 耿,王守力,等.急诊介入治疗后急性心肌梗死患者住院预后因素分析[J].中华心血管病杂志,2003,31(z1):53-54.
[7]韩雅玲,邓 捷,荆全民,等.急性心肌梗死急诊介入治疗无再流发生的独立预测因素及对长期预后的影响[J].中华心血管病杂志,2006,34(6):483-486.
[8]Chiladakis JA,Patsouras N,Manolis AS.The Bezold-Jarisch reflex in acute inferior myocardial infarction: clinical and sympathovagal spectral correlates[J].Clin Cardiol,2003,26(7):323-328.
[9]Bowers TR,O’neill WW,Pica M,et al.Patterns of coronary compromise resulting in acute right ventricular ischemic dysfunction[J].Circulation,2002,106(9):1104-1109.
[10]Berger PB,Ellis SG,Holmes DR,et al.Relationship between delay in performing direct coronary angioplasty and early clinical outcome in patients with acute myocardial infarction: results from the global use of strategies to open occluded arteries in Acute Coronary Syndromes(GUSTO-IIb)trial[J].Circulation,1999,100(1):14-20.
[11]Tang EW,Wong CK,Herbison P.Global registry of acute coronary events(GRACE)hospital discharge risk score accurately predicts long-term mortality post acute coronary syndrome[J].Am Heart J,2007,153(1):29-35.
[12]郭丽君，何立芸，高 炜.急性心肌梗死院内死亡患者临床特征分析[J].中华心血管病杂志,2005,33(3):42-45.
[13]Sanborn TL,Bates ER.Impact of thrombolysis intraaortic balloon pump counterpulsation,and their combination in cardiogenic shock complicating acute myocardial infarction:a report from the shock trial registry[J].Am Coll Cardiol,2000,36(3):1123-1129.
[14]Mishra S,Chu WW,Torguson R,et al.Role of prophylactic intra-aortic balloon pump in high-risk patients undergoing percutaneous coronary intervention[J].Am J Cardiol,2006,98(5):608-612.

备注/Memo

备注/Memo:
收稿日期：2014-03-01.通讯作者：黄立勋，主任医师，主要从事卫生管理研究Email:dyccg@126.com
作者简介：任晖，主任医师，硕士生Email:renhui4019@qq.com
更新日期/Last Update: 2014-07-10