急性心肌梗死并发心源性休克的危险因素分析

Analysis of risk factors of cardiogenic shock secondary to acute myocardial infarction

【摘要】目的从合并症中筛选急性心肌梗死（AMI）并发心源性休克（CS）的危险因素，为临床早期识别高危患者提供依据。方法对解放军总医院1993年1月至2009年12月17年中收治的5523例AMI患者资料进行回顾性分析，根据患者是否发生CS分为两组，应用多因素logistic回归模型筛选AMI患者并发CS的危险因素。结果5523例AMI患者中有197例发生了CS，发生率为3．57％；CS组30d住院病死率明显高于非cs组[55．33％（109／197）比7．49％（399／5326），P〈0．001]。Logistic回归分析显示，年龄[优势比（OR）=1．03，95％可信区间（95％CI）为1．02。1．05，P〈0．001]、陈旧性心肌梗死（OR=1．57，95％C!为1．13～2．19，P=0．007）、陈旧性脑梗死（OR=1．98，95％CJ为1．20～3．27，P=0．008）、慢性肾功能不全（OR=1．76，95％CI为1．23—2．51，P=0．002）、肺部感染（OR=1．72，95％CI为1．17～2．52，P=0．006）是AMI并发CS的独立危险因素。受试者工作特征曲线（ROC曲线）分析显示该模型有较高的判别cs患者的能力，ROC曲线下面积（AUC）为0．81（95％CI为0．75．0．85，P〈0．001）。结论高龄、合并陈旧性心肌梗死、陈旧性脑梗死、慢性肾功能不全、肺部感染多种疾病是AMI并发CS的危险因素。

Objective To explore risk factors for cardiogenic shock （CS） secondary to acute myocardial infarction （AMI） patients arising from comorbidities so as to identify high risk patients earlier. Methods A retrospective study was conducted on 5523 patients who were hospitalized with AMI in PLA General Hospital from January 1993 to December 2009. The patients were divided into two groups based on presence or absense of CS. Logistic regression analysis was used from comorbidities to evaluate the independent risk factors for CS. Results Among 5523 hospitalized AMI patients, 197 （3.57%） developed CS. The 30-day in hospital mortality rate of CS group was significantly higher than that of non-CS group [55.33% （109/197） vs. 7.49% （399/5326）, P〈0.0011- On the basis of logistic regression analysis, advanced age [odds ratio （OR）= 1.03, 95% confidence interval （95%CI） 1.02 - 1.05, P〈0.001 ~, previous attack of myocardial infarction （OR= 1.57, 95%CI 1.13 - 2.19, P=0.007）, history of stroke （ OR= 1.98, 95%CI 1.20 - 3.27, P=0.008）, chronic renal failure （ OR= 1.76, 95%CI 1.23 - 2.51, P=0.002） and pneumonia （ OR= 1.72, 95%CI 1.17 - 2.52, P=0.006） were independent risk factors for CS. Using receiver operator characteristic curve （ROC curve） analysis, the model was shown a good quality to judge the outcome of CS patients as the area under curve equals 0.81 （95%CI 0.75 - 0.85, P〈0.001 ）. Conclusion Advanced age and comorbidities including previous myocardial infarction, previous stroke, chronic renal failure and pneumonia were independent risk factors for CS.