IABP治疗急性心肌梗死合并心源性休克患者预后的影响因素分析

Analysis of prognostic factors of elderly patients with acute myocardial infarction complicated with cardiogenic shock treated with IABP

目的探讨影响应用主动脉内球囊反搏(IABP)治疗老年急性心肌梗死(AMI)合并心源性休克(CS)患者预后的危险因素。方法回顾性收集2010年3月至2015年5月由南阳市中心医院和河南省人民医院心内科收治的应用IABP治疗的AMI合并CS患者(n=46)的临床资料,Logistic回归分析影响AMI合并CS患者院内死亡的危险因素。随访出院患者至2018年5月,统计其生存率,COX风险回归模型分析影响AMI合并CS患者远期生存的危险因素。结果 46例患者院内死亡19例,死亡率41.30%,Logistic回归分析显示年龄、合并糖尿病、冠状动脉病变支数、术后TIMI血流分级、IABP并发心排量不足是应用IABP治疗的AMI伴CS患者院内死亡的危险因素。27例出院患者3年生存率62.96%,平均生存时间为(29.15±8.39)月,COX风险回归模型分析显示年龄、冠状动脉病变支数、术后TIMI血流分级是影响应用IABP治疗的AMI合并CS患者院外生存的危险因素。结论年龄、冠状动脉病变支数、术后TIMI血流分级是影响应用IABP治疗的AMI合并CS患者近远期预后的危险因素,临床对于高龄、多支冠状动脉病变,经皮冠状动脉介入治疗(PCI)后TIMI低级别患者应加强监护,积极采取补救措施以改善患者预后。

Objective To explore the risk factors affecting the prognosis of elderly patients with acute myocardial infarction(AMI) complicated with cardiogenic shock(CS) treated with IABP. Methods Clinical data of 46 elderly patients with AMI complicated with CS who received IABP treatment in the department of cardiology of Nanyang Central Hospital and Henan Province People’s Hospital, from March 2010 to May 2015 were collected retrospectively. Logistic regression analysis of risk factors for hospital death in AMI patients with CS. The discharged patients were followed up until May 2018, and their survival rate was calculated. COX regression analysis was conducted to analyze the risk factors affecting the long-term survival of patients with AMI combined with CS. Results Of the 46 patients, 19 had in-hospital deaths with a mortality rate of 41.30%. Logistic regression analysis showed that age, diabetes mellitus, coronary artery disease count, postoperative TIMI blood flow grading, and IABP complicated cardiac output were risk factors for hospital death. The 3-year survival rate of 27 patients discharged from hospital was 62.96%, and the average survival time was(29.15±8.39) months. COX risk regression model analysis showed that age, coronary artery disease count, and postoperative TIMI blood flow grading were risk factors for out-of-hospital survival. Conclusion Age, number of coronary artery lesions, and grade of postoperative TIMI blood flow are risk factors for short-term and long-term prognosis of AMI patients complicated with CS treated with IABP. In clinical practice, patients with advanced age and multiple coronary artery lesions with low grade TIMI after PCI should be under intensive care and take remedial measures to improve the prognosis of patients.