急性ST段抬高型心肌梗死患者早期低钾血症的发生情况及其与短期预后的相关性研究

Observation of hypokalemia and its effects on short-term prognosis in patients with acute ST-elevation myocardial infarction

目的探讨急性ST段抬高型心肌梗死（STEMI）患者早期低钾血症的发生情况及其与短期预后的相关性。方法选择2014年1月至2015年6月于首都医科大学附属北京安贞医院就诊的发病12h内的STEMI且接受介入治疗的患者1056例，根据患者入院后首次测定血钾水平分为低钾血症组（血钾〈3．5mmol／L，206例）和正常血钾组（血钾3．5～5．5mmol／L，850例）。观察并比较2组患者就诊时间、心肌梗死部位、肌酸激酶峰值、肌酸激酶同工酶峰值、住院死亡率、恶性心律失常发生率、住院时间、住院费用、介入治疗成功率以及置入支架数。结果2组患者就诊时间、罪犯血管为回旋支和右冠状动脉患者比例、住院死亡率、住院时间、介入治疗成功率、置入支架数差异均无统计学意义（均P〉0．05）。低钾血症组罪犯血管为前降支患者比例[50．5％（104／206）比42．2％（359／850）]、肌酸激酶峰值[（2572±1462）U／L比（1973±1025）U／L]、肌酸激酶同工酶峰值[（242±139）U／L比（202±117）U／L]、恶性心律失常发生率[12．6％（26／206）比7．8％（66／850）]、住院费用[（6．5±3．2）万元比（4．3±2．5）万元]均明显高于正常血钾组，差异均有统计学意义（均P〈0．05）。结论STEMI患者早期低钾血症发生率高，早期出现低钾血症提示短期预后较差。

Objective To analyze the occurrence of hypokalemia and its effects on short-term prognosis in patients with acute ST-elevation myocardial infarction （STEMI）. Methods Totally 1 056 patients with STEMI attack within 12 h who had accepted percutaneous coronary intervention（PCI） from January 2014 to June 2015 in Beijing Anzhen Hospital, Capital Medical University were divided into 2 groups by serum potassium levels： hypokalemia group （ serum potassium 〈 3.5 mmol/L, 206 cases ） and control group （ serum potassium 3.5- 5.5 mmo[/L, 850 cases）. The hospitalization time, infarction-related artery, ereatine kinase （CK）and creatine kinase-MB（CK-MB） peak values, hospital mortality, incidence of high risk arrhythmia, length of hospital stay, hospitalization expense, success rate of PCI and the number of stents in 2 groups were analyzed. Results The hospitalization time, proportion of patients with circumflex branch or right coronary artery infarction, hospital mortality, length of hospital stay, success rate of PCI and the number of stents had no significant difference between groups（P 〉 0. 05）. The proportion of patients with anterior descending branch infarction, creatine kinase peak value, ereatine kinase-MB peak value, incidence of high risk art＇hythmia and hospitalization expense in hypokalemia group were all significantly higher than those in control group [ 50. 5% （ 104/206 ） vs 42.2% （ 359/ 850）, （2 572 ± 1 462） U/L vs（ 1 973 ±1 025） U/L, （242 ± 139） U/L vs（202± 117） U/L, 12.6% （26/206） vs 7.8 % （66/850）, （ 6. 5 ± 3.2 ） millon vs （4. 3 ± 2. 5 ） millon ] （ P 〈 0. 05 ）. Conclusion Patients at early stage of STEMI have high incidenees of hypokalemia, which has severe effects on short-term prognosis.