2型糖尿病合并急性ST段抬高型心肌梗死药物溶栓效果影响因素分析

Influencing factors of pharmaceutical thrombolysis effect on type 2 diabetes mellitus combined with acute ST-segment elevation myocardial infarction

目的分析2型糖尿病(type 2 diabetes mellitus,T2DM)合并急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)药物溶栓效果的影响因素,为制订合理的治疗方案提供参考。方法回顾性分析2014年12月至2016年12月于本院接受药物溶栓(阿司匹林联合尿激酶)治疗的49例T2DM合并急性STEMI患者的临床资料,分析药物溶栓治疗效果及其相关影响因素。结果入组患者药物溶栓治疗后血管再通失败16例(32.65%),治疗后,心力衰竭、再发心肌梗死、恶性心律失常、治疗后30天死亡等不良心脏事件总发生率为57.14%,出血、肺部感染等并发症总发生率为34.69%。Logistic回归分析显示,年龄≥70岁、有吸烟史、合并高血压、有冠心病病史、多部位梗死、发病至就诊时间≥6小时均为影响T2DM合并急性STEMI患者溶栓治疗效果的危险因素(P_均<0.05)。结论 T2DM合并急性STEMI患者药物溶栓治疗整体效果较差,血管再通率较低,且治疗后发生不良心脏事件及并发症的风险较高。年龄、不良生活习惯、冠心病病史、多部位梗死及发病至就诊时间等均为影响治疗效果的关键因素。

Objective To analyze the influencing factors of pharmaceutical thrombolysis effect on type 2 diabetes mellitus(T2DM)complicated with acute ST-segment elevation myocardial infarction(STEMI),to provide a reference for formulating a reasonable treatment plan.Method The clinical data of 49 patients with T2DM combined with acute STEMI who received pharmaceutical thrombolysis therapy in our hospital from December 2014 to December 2016 were retrospectively analyzed,to explore the efficacy of thrombolytic therapy and its influencing factors.Result 16 patients(32.65%)failed to recanalization after thrombolytic therapy.The total incidence of adverse cardiac events such as heart failure,recurrent myocardial infarction,malignant arrhythmia and death 30 days after treatment was 57.14%,and the total incidence of complications such as bleeding and pulmonary infection was 34.69%.Logistic regression analysis showed that age>70 years,smoking history,hypertension,coronary heart disease history,multi-site infarction,onset to treatment time>6 hours were risk factors for thrombolytic therapy in T2DM combined with acute STEMI(Pall<0.05).Conclusion T2DM combined with acute STEMI patients treated with pharmaceutical thrombolysis has poor overall effect,lower revascularization rate and higher risk of adverse cardiac events or complications.Age,unhealthy lifestyle,history of coronary heart disease,multi-site infarction and onset to treatment time are the key factors of thrombolytic effect.