急性下壁或合并右心室心肌梗死患者左心衰竭的危险因素分析

Risk Factor Analysis for Left Heart Failure in Patients With Acute Inferior or Combining Right Ventricular Myocardial Infarction

目的 :探讨急性下壁或合并右心室心肌梗死患者心力衰竭(心衰)的危险因素。方法 :将我院2013-01至2015-06期间143例因急性下壁或合并右心室心肌梗死入院患者按是否发生心衰,分为心衰组81例,非心衰组62例,从年龄、性别、高血压等因素对心衰形成的危险因素进行回顾性分析。结果 :心衰组高血压、女性、超敏C反应蛋白、血肌酐、入院后第3天补液量、以V4~6导联ST段压低为主发生比例显著高于非心衰组,而入院时舒张压显著低于非心衰组。经多因素Logistic回归分析显示,高血压[OR=3.275,95%可信区间(CI):1.220~8.793)、女性(OR=13.236,95%CI:3.476~50.405)、超敏C反应蛋白(OR=1.029,95%CI:1.005~1.070)、入院时低舒张压(OR=0.945,95%CI:0.911~0.979)、血肌酐(OR=1.053,95%CI:1.029~1.078)、以V4~6导联ST段压低为主(OR=4.118,95%CI:1.395~12.154)均与心衰事件呈正相关。结论 :急性下壁或合并右心室心肌梗死患者发生心衰比例较高,且受多种因素影响。其中高血压、女性、入院时舒张压、超敏C反应蛋白、血肌酐、伴V4~6导联ST段压低为主是急性下壁或合并右心室心肌梗死患者发生心衰的独立危险因素。

Objective：To explore the risk factors for heart failure（HF） occurrence in patients with inferior or combining right ventricular myocardial infarction（MI）.Methods：A total of 143 patients with inferior or combining right ventricular myocardial infarction（MI） in our hospital from 2013-01 to 2015-06 were studied.Based on HF occurrence,the patients were divided into 2 groups：HF group,n=81 and Non-HF group,n=62.The risk factors related to HF occurrence as age,gender and hypertension were retrospectively studied and compared between 2 groups.Results：Compared with Non-HF group,HF group had more patients with hypertension,female gender,higher blood levels of Hs-CRP and creatinine,more volume of fluid input on the 3rd day of admission and the higher ratio of V4-6 ST segment depression in ECG;while obviously lower diastolic blood pressure（DBP） at admission.Multivariate Logistic regression analysis indicated that hypertension（OR=3.275,95% CI 1.220-8.793）,female gender（OR=13.236,95% CI 3.476-50.405）,Hs-CRP（OR=1.029,95% CI 1.005-1.070）,low DBP at admission（OR=0.945,95% CI 0.911-0.979）,serum creatinine（OR=1.053,95% CI 1.029-1.078） and V4-6 ST segment depression in ECG（OR=4.118,95% CI 1.395-12.154） were positively related to HF occurrence in relevant patients.Conclusion：The incidence of HF has been relatively high in patients with inferior or combining right ventricular MI;hypertension,female gender,low DBP at admission,blood level of Hs-CRP,serum creatinine,V4-6 ST segment depression in ECG were the independent risk factor for HR occurrence.