刘肖,李树仁,高楠,郑瑜,张一峰,党懿,刘惠良,孟存良,张飞飞,郝潇

• 1:河北北方学院研究生院
• 2:河北省人民医院心脏中心
• 3:保定第一中心医院心血管内科

摘要(Abstract)：

目的评估接受直接经皮冠状动脉介入治疗(PPCI)的ST段抬高型心肌梗死(STEMI患者住院期间的死亡因素。方法回顾性分析2016年9月至2018年6月在河北省人民医院心脏中心接受PPCI的392例STEMI患者的临床资料,根据是否发生院内死亡分为存活组和死亡组。通过logistic回归分析筛选出与死亡相关的危险因素。结果 392例STEMI行PPCI的患者中27例(6.9%)发生院内死亡。logistic单因素回归分析显示,性别(女)、年龄≥65岁、收缩压>140 mmHg(1 mmHg=0.133 kPa)、Killip心功能分级≥Ⅲ级、糖尿病、既往心房颤动史、院前应用他汀类药物、完全闭塞、多支病变、术后心肌梗死溶栓治疗试验(TIMI)血流≤Ⅱ级、术中心搏骤停、术中主动脉内球囊反搏、术后心搏骤停、术后心室颤动、术后心房颤动、术后室性心动过速、术后高度房室传导阻滞、术后消化道出血、白细胞计数、中性粒细胞计数、钙离子浓度、肌酐、尿酸、肌酸激酶同工酶(CK-MB)峰值、左心室射血分数(LVEF)≤40%是与死亡相关的危险因素,而术后使用血管紧张素转换酶抑制药/血管紧张素Ⅱ受体拮抗药、β阻滞药、他汀类、螺内酯药物是与患者生存相关的保护因素(均P<0.05)。logistic多因素回归分析显示,年龄≥65岁(OR 3.552,95%CI 1.086～11.62,P=0.036)、LVEF≤40%(OR 6.754,95%CI 1.982～23.02,P=0.002)、CK-MB峰值>25 U/L(OR 4.243,95%CI 1.219～14.77,P=0.023)、发病至球囊扩张时间≥195 min(OR3.490,95%CI 1.079～11.29,P=0.037)、术后TIMI血流分级≤Ⅱ级(OR 8.425,95%CI2.899～24.49,P<0.001)为STEMI患者行急诊PPCI术后发生院内死亡的独立预测因素。结论高龄、心功能差、CK-MB峰值升高、发病至球囊扩张时间、PPCI术后慢血流为STEMI患者行PPCI术后发生院内死亡的危险因素。

关键词(KeyWords)： ST段抬高型心肌梗死;经皮冠状动脉介入治疗;死亡;危险因素

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 刘肖,李树仁,高楠,郑瑜,张一峰,党懿,刘惠良,孟存良,张飞飞,郝潇

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