急性心肌梗死介入治疗后急性脑梗死发生率和危险因素研究

Incidence and Risk Factors of acute cerebral Infarction after percutaneous coronary Intervention in Patients with acute myocardial Infarction

目的研究急性脑梗死在介入治疗急性心肌梗死后发生率和危险因素。方法回顾性选取2016年1月至2020年1月河南信合医院心内科急性心肌梗死介入治疗患者600例,依据急性脑梗死发生情况分为发生组(n=25)、未发生组(n=575)两组,分析急性脑梗死在介入治疗急性心肌梗死后发生率和危险因素。结果600例急性心肌梗死患者中,介入治疗后发生急性脑梗死25例,发生率为4.2%。发生组患者的年龄显著高于未发生组(P<0.05),合并房颤率显著高于未发生组(P<0.05),发生脑梗死比例显著高于未发生组(P<0.05),血浆血小板计数(PLT)、血肌酐(Scr)水平均显著高于未发生组(P<0.05),活血凝血时间(ACT)显著短于未发生组(P<0.05),抗凝血酶(AT-Ⅲ)水平显著低于未发生率(P<0.05),术后低血压发生率显著高于未发生组(P<0.05)。以年龄、房颤、脑梗死史、球囊扩张次数、Scr和AT-Ⅲ作为自变量,急性脑梗死作为因变量进行Logistic回归分析,结果显示,急性脑梗死在介入治疗梗死史、有术后低血压、球囊扩张次数≥2次、Scr≥92μmol/L(P<0.05),保护因素为AT-Ⅲ≥224 mg/L(P<0.05)。结论急性脑梗死在介入治疗急性心肌梗死后发生率高,危险因素包括年龄、房颤、脑梗死史、术后低血压、球囊扩张次数、Scr,保护因素为AT-Ⅲ。

Objective To study the incidence and risk factors of acute cerebral infarction after percutaneous coronary intervention(PCI).Methods From January 2016 to January 2020,600 patients with acute myocardial infarction in department of cardiology of Henan Xinhe Hospital were selected and divided into two groups according to the occurrence of acute cerebral infarction,the patients were divided into two groups:the occurrence group(N=25)and the nonoccurrence group(N=575),the incidence and risk factors of acute cerebral infarction after percutaneous coronary intervention(PCI)were analyzed.Results Among 600 patients with acute myocardial infarction,25 had acute cerebral infarction after intervention therapy,the incidence rate was 4.2%.The age of the patients in the occurrence group was significantly higher than that in the non-occurrence group(P<0.05),the rate of atrial fibrillation was significantly higher than that in the non-occurrence group(P<0.05),and the rate of cerebral infarction was significantly higher than that in the non-occurrence group(P<0.05),the levels of platelet count(PLT)and creatinine(Scr)in plasma were significantly higher than those in non-occurrence group(P<0.05),the time of promoting blood coagulation(ACT)was significantly shorter than that in non-occurrence group(P<0.05),and the level of antithrombin(AT-Ⅲ)was significantly lower than that in non-occurrence group(P<0.05),the incidence of postoperative hypotension was significantly higher than that of the control group(P<0.05).Age,atrial fibrillation,history of cerebral infarction,times of balloon dilation,Scr and AT-Ⅲwere used as independent variables,and acute cerebral infarction was used as dependent variables for Logistic regression analysis,acute cerebral infarction had a history of infarction,postoperative hypotension,the number of times of balloon dilation≥2,Scr≥92μmol/L(P<0.05),and the protective factors were AT-Ⅲ≥224 mg/L(P<0.05).Conclusion The incidence of acute cerebral infarction is high after percutaneous coronary intervention.The risk factors include age,atrial fibrillation,history of cerebral infarction,postoperative hypotension,times of balloon dilation,Scr,the protective factor is AT-Ⅲ.