ST段抬高型心肌梗死患者溶栓再通后心力衰竭的影响因素研究

Influencing Factors of Heart Failure in STEMI Patients with Thrombolytic Recanalization

目的分析ST段抬高型心肌梗死(STEMI)患者溶栓再通后心力衰竭的影响因素。方法选取2013年5月—2015年5月西安医学院第二附属医院收治的STEMI患者112例,根据溶栓再通后心力衰竭发生情况分为心力衰竭组16例与非心力衰竭组96例。比较两组患者临床资料、实验室检查指标、左心室射血分数(LVEF)、心肌梗死部位和梗死面积(MIA),STEMI患者溶栓再通后心力衰竭的影响因素分析采用多因素Logistic回归分析。结果两组患者性别、高血压病史、心绞痛病史、舒张压、β-受体阻滞剂使用率、血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂(ACEI/ARB)使用率、尿酸(UA)、尿素氮(BUN)、C反应蛋白(CRP)、血肌酐(Scr)、同型半胱氨酸(Hcy)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)比较,差异无统计学意义(P>0.05);两组患者年龄、糖尿病病史、发病至血管再通时间、收缩压、γ-谷氨酰转肽酶(GGT)、空腹血糖(FBG)、三酰甘油(TG)、脑钠肽(BNP)、白细胞计数(WBC)、LVEF比较,差异有统计学意义(P<0.05)。两组患者前侧壁心肌梗死、下壁心肌梗死、右心室心肌梗死、右下壁并右心室心肌梗死、其他部位发生率比较,差异无统计学意义(P>0.05);心力衰竭组患者前壁心肌梗死、广泛前壁心肌梗死发生率高于非心力衰竭组(P<0.05)。心力衰竭组患者MIA大于非心力衰竭组(P<0.05)。多因素Logistic回归分析结果显示,发病至血管再通时间[OR=4.402,95%CI(1.682,12.734)]、收缩压[OR=1.092,95%CI(1.084,1.185)]、GGT[OR=1.183,95%CI(1.023,1.368)]、FBG[OR=2.146,95%CI(1.125,4.033)]、MIA[OR=1.655,95%CI(1.164,2.362)]为STEMI患者溶栓再通后心力衰竭的影响因素(P<0.05)。结论发病至血管再通时间、收缩压、GGT、FBG、MIA为STEMI患者溶栓再通后心力衰竭的影响因素。

Objective To analyze the influencing factors of heart failure in STEMI patients with thrombolytic recan＇,dization. Methods A total of 112 patients with STEMI were selected in the Second Affiliated Hospital of Xi＇an Medical College from May 2013 to May 2015, and they were divided into A group （complicated with heart failure, n = 16） and B group （did not complicate with heart failure, n = 96 ） according to the incidence of heart failure after thrombolytic recanalization. General information, laboratory test index, LVEF, myocardial infarction locations and myocardial infarction area were compared between the two groups, and the influencing factors of heart failure were analyze by multivariate Logistic regression analysis in STEMI patients with thrombolytic rccanalization. Results No statistically significant differences of gender, positive rate of hypertension history or angina pectoris history, DBP, usage rate of β - acceptor blockers or ACEI/ARB, UA, BUN, CRP, Ser, Hey, TC, HDL-C or LDL-C was found between the two groups （P 〉 0.05 ）, while there were statistically significant differences of age, positive rate of diabetes history, duration between attack and vascular recanalization, SBP, GGT, FBG, TG, BNP, WBC and LVEF between the groups （P 〈 O. 05）. No statistically significant differences of incidence of anterolateral myocardial infarction, inferior myocardial infarction, right ventrieular myocardial infarction, fight inferior complicated with right ventricular myocardial infarction or other location myocardial infarction was found between the two groups （P 〉 O. 05 ） , while incidence of anterior myocardial infarction and extensive anterior myocardial infarction of A group was statistically significantly higher than that of B group, respectively （ P 〈 0. 05 ）. Myocardial infarction area of A group was statistically significantly larger than that of B group （ P 〈 0. 05 ）. Multivariate Logistic regression analysis results showed that, duration between attack and vascular recanalization [ OR =4. 402, 95% CI （ 1. 682, 12. 734） ], SBP （ OR = I. 092, 95% CI （1.084, 1.185）i, GGT [OR=1.183, 95%CI （1.023, 1.368）3, FBG [OR=2.146, 95%CI （1.125, 4.033）] and myocardial infarction area （ OR = 1. 655, 95% CI （ 1. 164, 2. 362 ） ] were influencing factors of heart failure in STEMI patients with thrombolytie reeanalization （P 〈 0. 05 ）. Conclusion Duration between attack and vascular recanalization, SBP, GGT, FBG and myocardial infarction area are influencing factors of heart failure in STEMI patients with thrombolytic recanalization.