急性冠脉综合征患者急诊PCI术后心力衰竭的危险因素分析及护理干预

Analysis on the Risk Factors for Heart Failure in Acute Coronary Syndrome Patients after Emergency PCI and the Nursing Interventions

目的:探讨急性冠脉综合征(ACS)患者行急诊直接经皮冠状动脉介入治疗(PCI)后住院期间发生心力衰竭(HF)的危险因素分析及护理干预策略。方法:选取278例在我院接受急诊PCI手术患者为研究对象,按照术后住院期间是否出现心力衰竭分为两组:心力衰竭组(n=54例)和非心力衰竭组(n=224例),比较两组患者一般临床资料、实验室检查指标及相关治疗情况的差异,用Logistic回归分析探讨影响术后心力衰竭发生的危险因素,并制定相关护理策略。结果:278例老年患者中有54例PCI术后出现心力衰竭(发生率19.4%);两组患者在年龄、高血压、糖尿病、入院收缩压(SBP)、发病至PCI时间、入院血糖、入院NT-pro BNP、肌酸激酶同工酶(CK-MB)峰值、肌酐蛋白I(c Tn I)峰值、左室射血分数(LVEF)、左室舒张末内径(LVEDd)、术后TIMI血流、使用他汀类药物、β-受体阻滞剂方面存在统计学差异(P<0.05);发病至PCI时间、高血压、入院时血糖、NT-pro BNP、c Tn I峰值是术后心力衰竭发生的独立危险因素(P<0.05);而术后TIMI血流、使用β-受体阻滞剂治疗是保护性因素。结论:ACS患者行急诊PCI治疗后HF的发生受到多种因素的影响,应当积极制定相关护理干预策略以降低术后HF的发生率。

Objective： To discuss the risk factors for heart failure in acute coronary syndrome patients undergoing emergency PCI and the nursing interventions. Methods： The selected 278 cases of patients with emergency PCI surgery were taken as the research objects. According to that heart failure occurred or not in the postoperative hospital stay, they were divided into two groups： heart failure group（n = 54 cases） and the non-heart failure group（n = 224）. Compared the general clinical data, laboratory examination indexes and relevant differences in treatment between two groups. Logistic regression analysis was used to study the influence of risk factors for heart failure postoperatively, and formulate relevant nursing strategy. Results： Among the 278 cases of elderly patients, 54 cases had PCI postoperative heart failure（incidence of 19.4%）. Single factor analysis showed that there is a statistically significant difference in age,hypertension, diabetes, admission systolic blood pressure（SBP）, time from attack to PCI surgery, blood sugar, hospital admission NT-pro BNP, peak value of creatine kinase isoenzyme（CK-MB）, peak value of creatinine protein I（c Tn I）, left ventricular ejection fraction（LVEF）, left ventricular end-diastolic diameter（LVEDd）, postoperative TIMI flow, the use of statins and beta blockers（P〈0.05）. Multivariable Logistic regression analysis results showed that time from attack to PCI surgery, high blood pressure, blood sugar on admission, NT-pro BNP on admission, c Tn I peak were independent risk factors for postoperative heart failure（P〈0.05）. And postoperative TIMI flow and treatment with beta blockers were protective factors. Conclusion： The occurrence of heart failure of ACS patients after emergency PCI treatment were influenced by many factors, so we should actively develop related nursing intervention strategies to reduce the incidence of postoperative HF.