急性心肌梗死后心源性休克患者院内死亡情况分析及早期血运重建的影响

Analysis of hospital deaths in patients with cardiogenic shock after acute myocardial infarction and the effect of early revascularization

目的分析急性心肌梗死(AMI)后心源性休克患者院内死亡情况及影响因素,探讨早期血运重建是否为其保护因素并降低其院内死亡风险。方法回顾性分析2015年6月-2018年6月西安市长安医院心内科收治的110例AMI后心源性休克患者的临床资料,分析院内死亡情况及早期血运重建对降低院内死亡风险的作用。结果 AMI后心源性休克患者院内死亡率为73.64%,其中呼吸衰竭2例,多脏器功能衰竭2例,严重感染2例,支架内血栓形成3例,冠脉无复流7例,机械性并发症23例,心脏泵衰竭42例。根据院内转归情况将患者分为生存组(n=29)和死亡组(n=81),生存组和死亡组患者性别、年龄、广泛前壁心肌梗死、血运重建时间、血运重建后TIMI血流分级、AMI患病至入院时间、肾小球滤过率(GFR)、肌酸激酶同工酶(CK-MB)峰值、心肌肌钙蛋白T (cTnT)峰值、B型利钠肽(BNP)比较差异有统计学意义(P <0.05)。经Logistic回归分析显示,女性、年龄> 65岁、广泛前壁梗死、AMI患病至入院时间> 24 h、GFR <80 mL/(min·1.73m2)、CK-MB峰值> 148 U/L、cTnT峰值> 0.9 ng/L、BNP> 2 500 ng/L是AMI后心源性休克患者院内死亡的危险因素(P <0.05),而早期血运重建及血运重建后TIMI血流为Ⅱ~Ⅲ级是AMI后心源性休克患者院内死亡的保护因素(P <0.05)。结论 AMI后心源性休克患者院内死亡受多种因素影响,其中早期血运重建可作为保护因素以降低院内死亡风险。

Objective To analyze the hospital death and its influencing factors in patients with cardiogenic shock after acute myocardial infarction(AMI), and discuss early revascularization as to whether it can serve as a protective factor to reduce the risks of hospital deaths. Methods The clinical data of 110 patients with cardiogenic shock after AMI who were admitted to the impatient department of cardiology of Xi’an Chang’an Hospital during the period of June 2015 to June 2018 were retrospectively analyzed, and the hospital deaths and the effect of early revascularization in reducing death risk were analyzed. Results The hospital deaths rate of cardiogenic shock after AMI was 73.64%, with respiratory failure accounting for 2 cases, multiple organ failure for 2, serious infection for 2, stent thrombosis for 3, coronary no-reflow for 7, mechanical complications for 23 and heart pump failure for 42. The patients were divided into a survival(n=29) and death group(n = 81) according to the hospital prognosis, gender, age, extensive anterior myocardial infarction, revascularization time, TIMI flow grade after revascularization, time of AMI illness until admission, glomerular filtration rate(GFR), creatine kinase-MB(CK-MB) peak, cardiac troponin T(cTnT) peak, B-type natriuretic peptide(BNP) compared between the survival group and death group with statistically significant differences(P < 0.05). The Logistic regression analysis showed that female gender, being aged > 65 years, extensive anterior myocardial infarction, time of AMI illness until admission > 24 h, GFR < 80 mL/(min·1.73 m^2),CK-MB peak > 148 U/L, cTnT peak > 0.9 ng/L, BNP > 2 500 ng/L were risk factors for hospital death in patients with cardiogenic shock after AMI(P < 0.05), while early revascularization and TIMI flow after revascularization wasⅡ~Ⅲ were the protective factors for patients of cardiogenic shock after AMI(P < 0.05).Conclusion Hospital death is affected by many factors in patients with cardiogenic shock after AMI, and early revascularization may be used as a protective factor to reduce the risk of hospital death.