急性前壁心肌梗死患者出院后慢性心力衰竭的影响因素研究

Influencing Factors of Post-discharge Chronic Heart Failure in Patients with Acute Anterior Myocardial Infarction

目的分析急性前壁心肌梗死患者出院后慢性心力衰竭的影响因素。方法选取2014—2015年新疆医科大学第一附属医院收治的急性前壁心肌梗死患者167例,收集所有患者临床资料并在患者出院后通过门诊或电话随访12个月,记录其慢性心力衰竭发生情况。急性前壁心肌梗死患者出院后慢性心力衰竭的影响因素分析采用多因素Logistic回归分析。结果本组共153例患者完成随访,随访率为91.92%;发生慢性心力衰竭41例(心力衰竭组),未发生慢性心力衰竭112例(无心力衰竭组)。两组患者性别、体质指数、糖尿病发生率、高血压发生率、吸烟率、慢性阻塞性肺疾病病史、冠状动脉病变支数,入院时血肌酐水平、三酰甘油水平、左心室射血分数、左心室舒张末期内径、左心室收缩末期内径,住院期间新发心律失常者所占比例,出院时收缩压、舒张压、心率比较,差异均无统计学意义(P>0.05);两组患者胸痛发作至就诊时间、胸痛发作至闭塞血管开通时间、入院时室壁运动积分(WMS)、出院时N末端脑钠肽前体(NT-proBN)水平及经皮冠状动脉介入治疗(PCI)后无复流发生率比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,胸痛发作至就诊时间[OR=6.639,95%CI(2.972,14.829)]、胸痛发作至闭塞血管开通时间[OR=3.908,95%CI(1.031,14.817)]、入院时WMS[OR=3.287,95%CI(1.268,8.521)]及PCI后无复流[OR=3.561,95%CI(2.562,4.949)]是急性前壁心肌梗死患者出院后慢性心力衰竭的影响因素(P<0.05)。结论胸痛发作至就诊时间、胸痛发作至闭塞血管开通时间、入院时WMS及PCI后无复流是急性前壁心肌梗死患者出院后慢性心力衰竭的影响因素,应引起临床重视。

Objective To analyze the influencing factors of post-discharge chronic heart failure in patients with acute anterior myocardial infarction.Methods A total of167patients with acute anterior myocardial infarction were selected in the First Affiliated Hospital of Xinjiang Medical University from2014to2015,their clinical data was collected,and all of them received outpatient or telephone follow-up for12months after discharge,incidence of chronic heart failure was recorded.Influencing factors of post-discharge chronic heart failure in patients with acute anterior myocardial infarction was analyzed by multivariate Logistic regression analysis.Results The follow-up rate was91.92%(153/167),thereinto41cases occurred post-discharge chronic heart failure were served as observation group,the other112cases did not occurre post-discharge chronic heart failure were selected as control group.No statistically significant differences of gender,BMI,incidence of diabetes or hypertension,smoking rate,history of chronic obstructive pulmonary disease,number of stenosed coronary arteries,Scr,TG,LVEF,LVEDD or LVESD at admission,incidence of new arrhythmia during hospitalization,SBP,DBP or heart rate at discharge was found between the two groups(P>0.05),while there were statistically significant differences of duration between attack of chest pain and seeing a doctor,duration between attack of chest pain and recanalization of occlusive arteries,WMS at admission,NT-proBNP at discharge and incidence of no-flow phenomenon after PCI between the two groups(P<0.05).Multivariate Logistic regression analysis results showed that,duration between attack of chest pain and seeing a docto〔r OR=6.639,95%CI(2.972,14.829)〕,duration between attack of chest pain and recanalization of occlusive arteries〔OR=3.908,95%CI(1.031,14.817)〕,WMS at admission〔OR=3.287,95%CI(1.268,8.521)〕and no-flow phenomenon after PCI〔OR=3.561,95%CI(2.562,4.949)〕were influencing factors of post-discharge chronic heart failure in patients with acute anterior myocardial infarction(P<0.05).Conclusion Duration between attack of chest pain and seeing a docto,duration between attack of chest pain and recanalization of occlusive arteries,WMS at admission and no-flow phenomenon after PCI are influencing factors of post-discharge chronic heart failure in patients with acute anterior myocardial infarction,which should pay more clinical attentions to.