急性STEMI患者急诊PCI术中无复流影响因素分析

Influencing factors of non-reflow during emergency PCI in patients with STEAMI

目的探讨急性ST段抬高心肌梗死(STEAMI)患者行急诊PCI术中发生无复流的危险因素。方法连续选择因STEAMI住院符合急诊PCI治疗的患者88例,根据是否发生无复流分为正常血流组(n=73)和无复流组(n=15)。采用逐步筛选法选取自变量,多元logistic回归分析STEAMI患者急诊PCI后发生无复流的影响因素。结果 STEAMI患者行急诊PCI后无复流发生率为17.0%。无复流组与正常血流组患者间入院收缩压、合并2型糖尿病比例、肌钙蛋白T峰值、发病-再灌注时间、球囊扩张次数和靶血管置入数量比较,差异有统计学意义(P<0.05)。多因素logistic回归分析显示入院收缩压<100 mmHg(OR=1.019,95%CI:1.006～1.032)、合并2型糖尿病(OR=3.016,95%CI:1.984～3.245)、肌钙蛋白T峰值(OR=1.664,95%CI:1.242～1.845)、发病-再灌注时间(OR=2.988,95%CI:1.545～3.345)、球囊扩张次数(OR=1.864,95%CI:1.545～3.345),是急诊PCI术后无复流发生的独立危险因素(P<0.05)。结论 STEAMI患者行急诊PCI后无复流发生与入院SBP<100 mmHg、合并糖尿病、球囊扩张次数及发病-再灌注时间具有相关性。

Objective To investigate the risk factors of non-reflow during emergency percutaneous coronary intervention （PCI） in patients with acute ST-segment elevation acute myocardial infarction （STEAMI）. Methods The patients （n=88） hospitalized due to STEAMI and accorded with emergency PCI were divided into normal group （n=73） and non-reflow group （n=15）. The influencing factors of non-flow during emergency PCI were analyzed with multiple Logistic regression analysis after selecting independent variable by using stepwise method. Results The incidence rate of non-flow was 17.0%in STEAMI patients after PCI. The difference in in-hospital systolic blood pressure （SBP）, percentage of complicating type 2 diabetes, peak value of cTnT, morbidity-reperfusion time, times of balloon dilatation and number of target vessel implantation had statistical significance between 2 groups （P〈0.05）. The multiple Logistic regression analysis showed that in-hospital SBP （〈100 mmHg, OR=1.019, 95%CI：1.006-1.032）, complicating type 2 diabetes （OR=3.016, 95%CI：1.984-3.245）, peak value of cTnT （OR=1.664, 95%CI：1.242-1.845）, morbidity-reperfusion time （OR=2.988, 95%CI：1.545-3.345）, and times of balloon dilatation （OR=1.864, 95%CI：1.545-3.345） were independent risk factors of non-slow after emergency PCI （P〈0.05）. Conclusion The incidence of non-flow is correlated to in-hospital SBP （〈100 mmHg）, complicating type 2 diabetes, times of balloon dilatation and morbidity-reperfusion time in STEAMI patients with non-slow after emergency PCI.