急性心肌梗死并发心源性休克的临床特征

Clinical features of cardiogenic shock complicated by acute myocardial infarction

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％vs52％，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％vs8％，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。

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.