急性心肌梗死合并心原性休克患者临床特点及短期预后分析

Clinical features and short-term prognosis of patients with cardiogenic shock complicating acute myocardial infarction

目的:探讨急性心肌梗死(AMI)合并心原性休克(CS)患者临床特点及短期预后的影响因素。方法:本研究纳入2010年6月至2018年2月期间于中国医学科学院阜外医院冠心病中心住院的AMI合并CS患者,回顾性分析患者的临床特点及发病28 d的全因死亡风险,采用多因素logistic回归分析评价其预测因素。结果:本研究共纳入198例AMI合并CS患者,28d时共有128例患者死亡,短期全因死亡率为64.6%。与存活组比较,死亡组患者年龄更大,男性比例更高,体质量更低,收缩压和舒张压水平更低,ST段抬高型心肌梗死(STEMI)比例更低,既往经皮冠状动脉介入治疗(PCI)术后比例更高,合并高血压病、二尖瓣返流、消化道出血及昏迷的比例更高,使用有创机械通气的比例更高,差异均有统计学意义(P均<0.05)。此外,与存活组相比,死亡组患者的血红蛋白水平、血小板计数、血清白蛋白水平、动脉血酸碱度(pH)及碳酸氢根离子浓度更低,谷丙转氨酶、血肌酐、血尿素氮、血钠水平、血钾水平、N末端B型利钠肽前体(NT-proBNP)水平、D-二聚体及动脉血乳酸水平更高,差异均有统计学意义(P均<0.05)。多因素logistic回归分析结果显示,收缩压降低[比值比(OR)0.914,95%可信区间(CI)0.849~0.984,P=0.017)、动脉血pH降低(OR 0.021,95%CI 0.01~0.614,P=0.025)及血肌酐升高(OR 1.016,95%CI 1.006~1.025,P=0.002)是AMI合并CS患者发病28 d内全因死亡的独立预测因素。结论:AMI合并CS患者全因死亡率较高,入院时收缩压、动脉血pH及血肌酐是其发病28d内全因死亡的独立预测因素。

Objective:To investigate the clinical characteristics and short-term prognostic factors of patients with cardiogenic shock(CS)complicating acute myocardial infarction(AMI).Methods:Patients hospitalized in the Center of Coronary Heart Disease,Fuwai Hospital of Chinese Academy of Medical Sciences from June 2010 to February 2018 with the diagnosis of CS complicating AMI were enrolled and the clinical characteristics and 28d all cause death were evaluated retrospectively.Multivariate logistic regression analysis was used to identify the potential predictive factors.Results:A total of 198 patients with CS complicating AMI were enrolled in this analysis.At 28 d after onset of CS,128 patients died,showing the short-term all cause death rate of 64.6%.Compared with survivors,patients died were older,with more men,lower body mass,lower systolic and diastolic blood pressure,lower proportion of ST elevation myocardial infarction(STEMI),more history of percutaneous coronary intervention(PCI),hypertension,mitral regurgitation,gastrointestinal bleeding,coma and use of invasive mechanical ventilation(all P value<0.05).Moreover,there was significantly lower levels of hemoglobin,platelet count,serum albumin,arterial pH and bicarbonate ions,higher levels of alanine aminotransferase,serum creatinine,blood urea nitrogen,serum sodium,serum potassium,N terminal-pro B type natriuretic peptide(NT-proBNP),D-Dimer and lactic acid(all P value<0.05).Multivariate logistic regression analysis showed that lower systolic blood pressure[odds ratio(OR)0.914,95%confidence interval(CI)0.849-0.984,P=0.017],lower arterial pH(OR 0.021,95%CI 0.01-0.614,P=0.025)and higher serum creatinine(OR 1.016,95%CI 1.006-1.025,P=0.002)were independent predictors of short-term all-cause death for patients with CS complicating AMI.Conclusion:There was still higher short-term mortality for patients with CS complicating AMI and lower systolic blood pressure,lower arterial pH and higher serum creatinine on admission were independent predictors of short-term mortality among this population.