急性下壁ST段抬高型心肌梗死患者左心衰竭的危险因素分析

Risk factors for left heart failure in patients with acute inferior ST-segment elevation myocardial infarction

目的探讨急性下壁ST段抬高型心肌梗死患者发生左心衰竭的影响因素,为临床防治措施的制定提供依据。方法将沧州市人民医院2013年1月至2018年1月收治的534例急性下壁ST段抬高型心肌梗死患者作为此次研究对象,回顾性分析这些患者的临床病历资料,并查阅患者病史等,将发生心力衰竭的患者(162例)作为观察组,将未发生心力衰竭的患者(372例)作为对照组。比较两组年龄、性别、病史等情况,并加以分析。结果观察组患者女性、原发性高血压(高血压)、血肌酐浓度、完全血运重建治疗、超敏C反应蛋白浓度和入院后第3天补液量及以V4~6导联ST段压低的发生率明显高于对照组,而患者入院时舒张压明显低于对照组,差异有统计学意义(P<0.05)。多因素回归分析结果发现,女性、高血压、超敏C反应蛋白浓度、完全血运重建治疗、入院时低舒张压、血肌酐浓度、V4~6导联ST段压低是急性下壁ST段抬高型心肌梗死患者发生左心衰竭的主要高危因素(P<0.05)。结论急性下壁ST段抬高型心肌梗死患者发生左心衰竭率较高,且发病受多种因素影响,因此,要针对高危因素加以干预,以改善患者预后。

Objectives To investigate the influencing factors of left heart failure in patients with acute inferior STsegment elevation myocardial infarction,and to provide evidence for clinical control measures.Methods Totally 534 patients with acute inferior ST-segment elevation myocardial infarction admitted to People′s Hospital of Cangzhou City from January 2013 to January 2018 were included in the study.The clinical medical records of the patients were retrospectively analyzed,and the patients′medical history was reviewed.The patients with heart failure(162 cases)were treated as observation group,and those without heart failure(372 cases)were as control group.The age,sex and medical history of the two groups were compared and analyzed.Results The patients′percentage of female,hypertension,complete revascularization therapy,serum concentrations of creatinine,hypersensitive C-reactive protein,fluid infusion volume on the third day after admission and ST-segment depression in V4-6 lead in observation group were significantly higher than those in control group(P<0.05),the diastolic blood pressure was significantly lower than that of control group(P<0.05).Multivariate analysis showed that female,hypertension,hypersensitive C-reactive protein,complete revascularization therapy,low diastolic blood pressure at admission,serum creatinine and ST-segment depression in lead V4-6 were the main risk factors for left heart failure in patients with acute inferior ST-segment elevation myocardial infarction(P<0.05).Conclusions Patients with acute inferior ST-segment elevation myocardial infarction have a higher rate of left heart failure,and the incidence is affected by many factors,so it is necessary to intervene and to improve the prognosis of patients with high risk factors.