经皮冠状动脉介入治疗ST段抬高型心肌梗死患者预后的影响因素探究

Prognosis influence factors of percutaneous coronary intervention for patients with ST elevation myocardial infarction

目的：探究经皮冠状动脉介入治疗（ PCI）ST段抬高型心肌梗死（ STEMI）患者的预后影响因素，为改善患者预后及生存质量提供理论依据。方法选取晋城巿人民医院2007年9月至2010年4月收治的182例接受PCI治疗的STEMI患者的临床资料，按照其存活状态分为未病死组（n=105）及病死组（n=77），对两组患者的临床特点进行回顾分析对比，并将存在统计学差异的特点纳入Logistic多因素回归分析。结果单因素分析发现，两组患者年龄、症状开始至再灌注时间、性别、合并糖尿病、心肌梗死史、心功能Killip’s分级、血管病变程度及使用药物等临床特点比较差异有统计学意义（ P﹤0.05）；多因素回归分析发现，年龄较大、症状开始至再灌注时间较长、合并糖尿病、血管病变≥2支及未使用β-受体阻滞剂、血管紧张素转化酶抑制剂（ ACEI）或血管紧张素Ⅱ受体阻滞剂（ARB）是影响影响PCI治疗STEMI患者预后的独立危险因素（P﹤0.05）。结论年龄较大、症状开始至再灌注时间较长、合并糖尿病、血管病变≥2支及未使用β-受体阻滞剂、ACEI或ARB等因素会导致STEMI患者预后较差，因此，在患者入院后应采取一切措施缩短自症状开始至再灌注时间，并积极纠正高血糖、改善心功能及使用扩血管药物，以改善患者预后，保证其生存质量。

Objective To investigate the prognosis influence factors of percutaneous coronary intervention（ PCI）for ST segment elevation myocardial infarction（ STEMI）factors,and provide theoretical basis for improving the prognosis and quality of life. Methods The data of 182 STEMI patients treated by PCI in the people’s hospital of Jincheng from September 2007 to April 2010 were divided into nondeath group（n=105）and death group（n=77）according to their survival state. The clinical characters were retrospectively analyzed,and characteristics of statistical difference were into multiple Logistic regression analysis. Results The single factor analysis showed that there were significant differences in the clinical features including age,the first symptom and the reperfusion time,gender,diabetes mellitus, history of myocardial infarction,cardiac function in Killip ’s classification,degree of vascular lesions and drug use（P﹤0. 05）;Multiple regression analysis showed that older age,symptoms begin,to reperfusion time longer,diabetes,vascular lesions≥2 and without the use of beta blockers,ACEI or ARB were independent prognostic factors of PCI in the treatment of STEMI（ P ﹤0. 05 ）. Conclusions Older age, symptoms begin,to reperfusion time longer,diabetes,vascular lesions ≥2 and without the use of beta blockers,all the above factors will lead to poor outcome in patients with STEMI,therefore,after admission the patient should take all measures to shorten the symptom onset to reperfusion time,and actively correct high blood glucose,improve heart function and the use of vasodilators,in order to improve the prognosis of patients,ensure the quality of life.