急性ST段抬高型心肌梗死患者再灌注治疗预后的影响因素

Effect of age and hemoglobin on the prognosis of patients with acute ST-segment elevation myocardial infarction after reperfusion

目的探讨急性ST段抬高型心肌梗死(STEMI)患者再灌注治疗预后的影响因素。方法选取2012年1月～2015年1月于我院行再灌注治疗的126例STEMI患者作为研究对象,采用回顾性分析所有患者的临床及随访资料,根据其资料结果记录所有患者的性别、年龄、疾病史等一般临床资料,疾病情况、血红蛋白等相关临床指标水平以及再灌注治疗后的预后效果,并比较不同预后效果患者间上述资料的差异性。分析影响再灌注治疗STEMI患者预后的因素。结果 126例STEMI患者经再灌注治疗后预后好106例(84.13%),预后差20例(15.87%);年龄≥60岁的STEMI患者其女性和糖尿病比例以及心功能killip分级较高,而吸烟和饮酒患者较少,血红蛋白水平较低,预后较差(P<0.05);中、重度贫血患者其女性、吸烟、糖尿病比例和年龄及心功能能killip分级均高于非贫血和轻度贫血者,且前两者预后更差比较差异间均具有统计学意义(P<0.05);既往存在糖尿病病史,有吸烟、喝酒习惯,心功能killip分级过高、血脂异常以及年龄≥60岁和中、重度贫血的STEMI患者经再灌注治疗后其预后较差(P<0.05);经非条件多因素Lgistic回归模型分析显示,killip分级过高、血脂异常以及年龄≥60岁和中、重度贫血是影响STEMI再灌注治疗预后效果的独立危险因素(P<0.05)。结论 STEMI患者经再灌注治疗后的预后效果尚可,年龄≥60岁和中、重度贫血等均为影响STEMI再灌注治疗预后效果的独立危险因素,可将其联合作为临床上评估STEMI患者经再灌注治疗预后效果的有效指标。

Objective To investigate the effect of age and hemoglobin on the prognosis of patients with ST-segment elevation acute myocardial infarction (STEMI) after reperfusion therapy.Methods 126 patients with STEMI treated with reperfusion in our hospital from January 2012 to January 2015 were enrolled.The clinical and follow-up data of all patients were analyzed retrospectively.According to the results of the data,the general clinical data such as gender,age,and disease history of all patients,the related clinical indicators such as disease situation and hemoglobin and prognostic effects after reperfusion therapy were recorded.The differences in the above data between patients with different prognostic effects were compared.Results In 126 patients with STEMI,106 patients had a good prognosis after reperfusion treatment,accounting for 84.13%,and the prognosis of 20 patients was poor,accounting for 15.87%.In STEMI patients who was more than 60 years,the proportion of women and diabetes was low and the killip classification of cardiac function was low,while there were fewer smokers and alcoholics,and they had lower hemoglobin level and poorer prognostic effects (P<0.05).The proportion of women,smoking and diabetes,age,and the killip classification of cardiac function in patients with moderate to severe anemia were significantly higher than that in patients with no anemia and mild anemia,and the difference in worse prognosis of the former two groups was statistically significant (P<0.05).STEMI patients who had a history of diabetes,and habits of smoking,drinking,had exorbitant killip classification of cardiac function,dyslipidemia and moderate to severe anemia,and was more than 60 years,had a poor prognosis after reperfusion (P<0.05).The unconditional multivariate Lgistic regression model showed that the exorbitant killip classification,dyslipidemia,age more than 60 years old and moderate to severe anemia were independent risk factors for the prognostic effects of STEMI after reperfusion (P<0.05).Conclusion The prognostic effects of STEMI patients after reperfusion therapy is acceptable.However,age more than 60 years old and the presence of moderate to severe anemia are independent risk factors affecting the prognostic effects of STEMI after reperfusion therapy.They can be combined as an effective indicator for clinical evaluation of the prognostic effect in STEMI patients after reperfusion therapy.