高血压对ST段抬高型心肌梗死患者院内主要不良心脏事件的影响

Effect of hypertension on the in-hospital major adverse cardiac events in patients with ST-segment elevation myocardial infarction

目的探讨高血压对ST段抬高型心肌梗死（STEMI）患者院内主要不良心脏事件（MACE）的影响。方法随机选取2001、2006、2011年于我院住院的STEMI患者217例，根据有无高血压病史分为高血压组73例和无高血压组144例，比较两组患者院内MACE的发生情况及2001、2006、2011年高血压组患者院内MACE的发生情况、入院时降血压药物的使用情况。结果高血压组患者院内总MACE、不稳定型心绞痛、心力衰竭及死亡发生率均高于无高血压组（P〈0．05），而两组间院内再次心肌梗死发生率比较，差异无统计学意义（P〉0．05）。2001、2006、2011年高血压组院内总MACE、心力衰竭发生率、入院时使用血管紧张素转化酶抑制剂（ACEI）／血管紧张素Ⅱ受体拮抗剂（ARB）、β受体阻滞剂患者比例比较，差异均有统计学意义（P〈0．05），且从2001～2011年高血压组院内心力衰竭发生率呈下降趋势，入院时使用ACEI／ARB和β受体阻滞剂患者比例均呈上升趋势。而3年间院内不稳定型心绞痛、再次心肌梗死、死亡发生率及入院时使用利尿剂、钙离子拮抗剂患者比例比较，差异均无统计学意义（P〉0．05）。结论高血压增加STEMI患者院内MACE的发生率。从2001—2011年我院STEMI合并高血压患者入院时ACEI／ARB及β受体阻滞剂的应用率呈上升趋势，而院内心力衰竭发生率呈下降趋势。

Objective To investigate the effect of hypertension on major adverse cardiac events （MACE） in patients with ST-segment elevation myocardial infarction （STEMI）. Methods According to with hypertension or not,217 patients with STEM I admitted to our hospital in 2001,2006 and 2011 were divided into hypertension group （ 73 cases ） and non-hypertension group （ 144 cases ）. The incidences of MACE were compared between hypertension group and non-hypertension group. The incidences of MACE and the use of antihypertensive drugs on admission were compared among patients in hypertension group in 2001,2006 and 2011. Results The incidences of total MACE, unstable angina pectoris, heart failure and death of patients in hypertension group were significantly higher than those in non-hypertension group （ P 〈 0.05 ） , but there was no significant difference in the incidence of recurrent myocardial infarction between two groups （ P 〉 0.05 ）. The incidences of total MACE, in-hospital heart failure, proportion of patients who used angiotensin converting enzyme inhibitors （ACEI）/angiotensin Ⅱ receptor antagonists （ARB） and β-receptor blockers on admission were significantly different between 2001,2006 and 2011 in hypertension group（P 〈 0.05 ）. From 2001 to 2011, the incidence of heart failure in hypertension group showed a downward trend ,while the proportions of patients who used ACEI/ARB and β-receptor blockers on admission showed an upward trend. There were no significant differences in incidences of unstable angina pectoris,recurrent myocardial infarction,death,proportions of patients who used diuretics and calcimn antagonists on admission in hypertension group among 2001,2006 and 2011 （ P 〉 0.05 ）. Conclusion Hypertension increases the incidence of in-hospital MACE of STEMI patients. From 2001 to 2011, the rates in using ACEI/ARB and β-receptor blockers in STEMI patients with hypertension in our hospital show a upward trend, while the incidence of heart failure showes an downward trend.