急性ST段抬高型心肌梗死患者PCI术后急性肾损伤与超声心动参数的相关性研究

Study of the relationship between the acute renal injury and the parameters of echocardiography parameters in patients with PCI after STEMI

目的探讨急性STEMI患者行PCI术后出现AKI与超声心动图参数的相关性。方法选取我院2014年6月至2015年12月急性ST段抬高型心肌梗死行PCI手术200例患者的临床资料,根据术后48h血肌酐增高水平分为两组。对比分析两组患者的一般资料和超声心动图参数,并进一步应用二分类Logistics回归分析行相关风险因素分析。结果 200例急性ST段抬高型心肌梗死行PCI手术患者中,共有19例出现急性肾损伤(9.5%,19/200),与对照组患者相比,观察组合并心衰率(47.4%,9/19)、再灌注时间(395.2±287.4)min及术后肌酐峰值(2.13±1.12)mg/dL明显更高(P<0.05),观察组患者的心输血量(4.5±1.3)L/min、射血分数(48.7±8.3)%明显更低,且右心房压力(8.3±2.9)mmHg明显更高(P<0.05),多因素Logistic回归分析结果显示,射血分数、出现心衰、再灌注时间及心输血量是急性ST段抬高型心肌梗死行PCI手术后出现AKI的风险因素(P<0.05)。结论较低的射血分数、出现心衰、再灌注时间及心输血量患者术后AKI风险增加,PCI围手术期重点评估AKI风险,并进行有效预防,从而提高患者临床疗效及生活质量,改善预后。

Objective To determine the relationship between the acute renal injury and the parameters of echocardiography parameters in patients with STEMI after PCI. Methods The clinical data of patients with acute STEMI who underwent PCI were selected in our hospital from December 2015 to June 2014. According to the level of 48h serum creatinine,patients were divided into two groups. Comparative analysis of the two groups of patients with general information and echocardiographic parameters. The related risk factors were further analyzed by the two classification Logistics regression analysis. Results A total of 19 patients occurred acute renal injury （9.5%, 19/200） after underwenting PCI operation among the 200 cases with acute STEMI. Compared with the control group,the heart failure rate （47.4% ,9/19）,reperfusion time （395.2±287.4）min and postoperative creatinine peak （2.13± 1.12）mg/dL in the observation group were significantly higher （P〈0.05）. The heart blood volume （4.5±1.3）L/min,ejection fraction （48.7±8.3） in the observation group were significantly lower,and right atrial pressure （8.3±2.9）mmHg in the observation group were significantly higher （P〈0.05）. The ejection fraction, heart failure, the time of reperfusion and cardiac output were the risk factors for AKI of patients with acute ST segment elevation myocardial infarction undergoing PCI surgery （P〈0.05）. Conclusion Patients with lower ejection fraction,heart failure and reperfusion time may have an increased risk of AKI. The risk of AKI should be assessed in the perioperative period of PCI so as to improve the clinical efficacy and quality of life, and further improve prognosis.