入院收缩压对急性ST段抬高心肌梗死预后的研究

Research of systolic blood pressure at admission on in-hospital outcomes in patients with ST elevated acute myocardial infarction

目的 研究入院时收缩压（systolic blood pressure-SBP）水平对急性ST段抬高心肌梗死（STEMI）在院期间预后的影响.方法 回顾性分析中国医科大学附属盛京医院2008年9月至2011年6月收治入院的335例STEMI患者,根据入院时SBP水平将335例STEMI患者分为4组,分别是：＜101 mmHg（1 mmHg=0.133 kPa） （n=59）,101～120 mmHg （n=109）,121 ～140mmHg（n=98）,＞140 mmHg （n =69）.比较各组的基本临床资料、冠状动脉造影发现（coronary angiography,CAG）、治疗方法、院内并发症和院内病死率.结果 各组STEMI患者院内病死率分别是18.64％、1.83％、4.08％、1.45％,入院SBP＜ 101 mmHg组病死率、killip≥3级、休克、严重心律失常发生率及经安装起搏器、IABP治疗率均高于其他3组.SBP≥101 mmHg的3组病死率没有明显差别.经多因素Logistic回归分析显示SBP＜ 101 mmHg（OR=6.368,P=0.002）、肌钙蛋白Ⅰ峰值（OR=3.781,P=0.008）是入院STEMI患者死亡的独立危险因素.结论 入院SBP＜ 101 mmHg患者在院期间病死率高,入院收缩压低可作为判断STEMI患者预后不良的一个较好指标.

Objective To investigate the impact of systolic blood pressure （SBP） at admission on in-hospital outcomes in patients with ST elevated acute myocardial infarction （STEMI）.Methods Data of 336 STEMI patients admitted from September 2008 to May 2011 were retrospectively analyzed.Total of 336 STEMI patients were classified into 4 groups as per the level of SBP at admission：group A （＜ 101 mmHg,n =59） ; group B （101-120 mmHg,n =109） ; group C （121-140 mmHg,n =98） and group D （＞ 140 mmHg,n =69）.And clinical features,coronary angiography （CAG） findings,the strategy of treatment,complications and hospital mortality were compared among 4 groups with SPSS version 18.0 software.Results The mortality rates of the four groups were 18.64％,1.83％,4.08％,1.45％,respectively.The patients with SBP ＜ 106 mmHg were in greater risk of in-hospital mortality,Killip class ≥ 3 at admission,shock and refractory arrhythmias,and more patients in this group needed pacemaker and intraaortic balloon pump （IABP） treatment than patients in other 3 groups.While there was no significant difference in mortality rate between other three groups.Multivariate logistic regression analysis demonstrated SBP ＜ 101 mmHg （OR =6.368,P =0.002） and peak value of troponin Ⅰ （OR =3.781,P =0.008） were independent risk factors of in-hospital death in STEMI patients.Conclusions The STEMI patients with SBP ＜ 101 mmHg at admission had higher mortality rate and low SBP at admission had great prognostic value in short-term outcomes of STEMI.