经皮冠状动脉介入法治疗急性ST段抬高型心肌梗死的短期死亡率与护理的相关性分析

The relationship between TISS-28 and short-term mortality in patients with acute ST segment elevation infarction after PCI treatment

目的探讨经皮冠状动脉介入法治疗急性ST段抬高型心肌梗死(STEMI)的短期死亡率与护理的相关性。方法选取2013年8月至2016年8月明确诊断为STEMI并行急诊PCI患者312例,随访30天,依据患者存活状态分为存活组和死亡组。采用治疗干预评分系统-28评分系统(TISS-28)评价患者入院时护理工作量。结果死亡组患者年龄、总胆固醇(TC)、左室射血分数(LVEF)、高敏C反应蛋白(Hs-CRP)、冠脉病变血管数、高脂血症、肌钙蛋白T(c Tn T)、梗死相关血管、Gensini积分、平均工作量(TISS-28)与存活组比较,差异均有统计学意义(P<0.05)。护理工作量随冠脉病变支数数量的增多而加大(P<0.05)。单因素Cox回归分析显示年龄、TC、Hs-CRP、c Tn T、LVEF、冠脉病变累及血管数、Gensini、TISS-28与死亡相关(P<0.05)。多因素Cox回归分析显示年龄、c Tn T、LVEF、Gensini、TISS-28为死亡的独立影响因素。Person相关性分析提示,TISS-28和Gensini积分(r=0.291,P=0.003)、年龄(r=0.191,P=0.008)、c Tn T(r=0.091,P=0.022)和LVEF(r=0.391,P<0.001)呈正相关关系。结论入院时护理工作量可作为急性STEMI患者冠脉病变严重程度及短期死亡的预测因子。

Objective To investigate the relationship between TISS-28 and short-term mortality in patients with acute ST segment elevation infarction after PCI treatment.Methods From August 2013 to August 2016 ,312 patients undergone PCI were diagnosed as ST segment elevation myocardial infarction （STEMI） and received emergency treated.The patients were followed up for 30 days and divided into survival and death groups.The TISS-28 was used to evaluate the nursing workload when the patients were admitted.Results There were significant differences in age,hyperlipidemia,TC,Hs-CRP,cTnT,LVEF,number of coronary artery disease,infarct related vessels, Gensini scores and average workload between the two groups （P〈0.05 ） . The TISS-28 was increased with the increase of the number of coronary lesions and the number of implanted stents （P〈0.05 ）.Single factor Cox regression analysis showed that age, TC,Hs-CRP,cTnT,LVEF,coronary artery lesions,number of vessels involved,Gensini scores and TISS-28 were related to mortality （P 〈0.05） .Multivariate Cox regression analysis showed that age, cTnT, LVEF, Gensini scores and HSS-28 were independent influencing factors of death.Person correlation analysis suggested that TISS-28 was positively correlated with Gensini scores （ r= 0.291, P= 0.003） ,age （r= 0.191 ,P=0.008） and LVEF （ r=0.391 ,P〈 0.001） . Conclusion TISS-28 is closely related to the severity of coronary lesions in patients with acute STEMI and can be used as a prognostic predictor for patients with acute STEMI.