急诊经皮冠状动脉介入治疗中梗死相关动脉再通后低血压的相关因素分析Relative factors of hypotension after recanalization of infarction related artery during emergency percutaneous coronary intervention
刘永兴,贾大林,齐国先,曾定尹
摘要(Abstract)：
目的探讨急性心肌梗死(acute myocardial infarction,AMI)患者行急诊经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术中梗死相关动脉(infarction related artery,IRA)再通后低血压的相关因素。方法回顾性分析中国医科大学第一医院自2003年1月至2006年9月首次AMI接受急诊PCI的245例连续性患者的临床和冠状动脉造影资料。排除急诊PCI术中再灌注后血压高于正常者27例,将218例患者按再灌注后血压情况分为两组,即低血压组102例和正常血压组116例,运用Logistic回归分析低血压的相关因素。结果低血压组中年龄在60岁以上、PCI前Killip分级≥2级、下壁或右室梗死、右冠状动脉病变、病变血管为近段或完全闭塞病变、多支血管病变和IRA开通后TIMI血流≤1级的发生率明显高于正常血压组(分别为56.9%比37.9%,36.3%比22.4%,50.8%+13.6%比28.8%+1.6%,54.9%比18.1%,60.8%+87.3%比43.1%+66.4%,68.6%比54.3%和15.7%比7.8%),且低血压组患者的住院死亡率明显增高(11.8%比1.7%),差异均有统计学意义(P均<0.05)。而Logistic回归分析表明:低血压的相关因素为年龄≥60岁、Killip≥2级、下壁梗死、右冠状动脉病变、近段血管病变及完全闭塞病变(P<0.05,OR>1)。结论60岁以上老年人、Killip分级≥2级、下壁梗死、右冠状动脉病变、病变血管为近段或完全闭塞病变是AMI患者急诊PCI术中IRA再通后低血压的危险因素,而且低血压的发生明显增加患者的住院死亡率。
关键词(KeyWords)： 心肌梗死;血管成形术,经腔,经皮冠状动脉;支架;冠状血管;低血压
基金项目(Foundation):
作者(Author): 刘永兴,贾大林,齐国先,曾定尹
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