急性心肌梗死后心力衰竭的临床特点分析

Analysis of clinical characteristics of heart failure after acute myocardial infarction

目的分析急性心肌梗死后并发心力衰竭患者的临床特点。方法回顾性选取2019年4月至2020年4月福建省南平市第二医院收治的90例急性心肌梗死(AMI)患者为研究对象,按照患者是否并发心力衰竭分为两组,56例未并发心力衰竭的患者纳入单一心梗组,34例并发心力衰竭的患者纳入合并心衰组,比较两组的临床特点。结果合并心衰组的年龄、女性占比高于单一心梗组,差异有统计学意义(P<0.05),而两组合并高血压率、合并糖尿病率、合并高脂血症率、吸烟史率、冠状动脉旁路移植术史率比较,差异无统计学意义(P>0.05)。生化指标方面,合并心衰组的收缩压、舒张压、血红蛋白低于单一心梗组,血肌酐、血尿酸、肌酸激酶、脑钠肽水平高于单一心梗组,差异有统计学意义(P<0.05);两组的总胆固醇、三酰甘油、低密度脂蛋白胆固醇水平比较,差异无统计学意义(P>0.05)。用药情况方面,合并心衰组的利尿剂使用率高于单一心梗组,β受体阻滞剂和血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂使用率低于单一心梗组,差异有统计学意义(P<0.05);两组介入治疗、他汀类药物、阿司匹林、氯吡格雷使用率差异均无统计学意义(P>0.05)。合并心衰组的住院时间长于单一心梗组,差异有统计学意义(P<0.05)。合并心衰组的心脏破裂、肾功能不全、恶性心律失常、室壁瘤、栓塞、死亡发生率与单一心梗组比较,差异无统计学意义(P>0.05)。结论AMI后并发心力衰竭的患者临床特点与单一AMI存在一定差异,且并发心力衰竭后的急性心肌梗死患者死亡风险更高,介入治疗是临床有效的方法。

Objective To analyze the clinical characteristics of patients with heart failure after acute myocardial infarction.Methods A total of 90 patients with acute myocardial infarction(AMI)admitted to the Second Hospital of Nanping City,Fujian Province from April 2019 to April 2020 were selected retrospectively as the research subjects.Patients were divided into two groups according to whether patients complicated with heart failure or not.56 patients without complicated with heart failure were included in the single myocardial infarction group,and 34 patients with complicated with heart failure were included in the combined heart failure group.The clinical characteristics of the two groups were compared.Results The age,proportion of female in the combined heart failure group were higher than those in the single myocardial infarction group,and the differences were statistically significant(P<0.05).There were no significant differences in the rates of hypertension,diabetes,hyperlipidemia,smoking history and coronary artery bypass transplantation between the two groups(P>0.05).In terms of biochemical indicators,systolic blood pressure,diastolic blood pressure and hemoglobin in the combined heart failure group were lower than those in the single myocardial infarction group,and the levels of serum creatinine,serum uric acid,creatine kinase and brain natriuretic peptide were higher than those in the single myocardial infarction group,the differences were statistically significant(P<0.05).There were no significant differences in total cholesterol,triglyceride and low density lipoprotein cholesterol levels between the two groups(P>0.05).In terms of drug use,the utilization rate of diuretics in the combined heart failure group was higher than that in the single myocardial infarction group,and the utilization rate of β-blockers and angiotensin converting enzyme inhibitor/angiotensin receptor blockers was lower than that in the single myocardial infarction group,the differences were statistically significant(P<0.05).There were no significant differences in the use rates of interventional therapy,statins,aspirin and clopidogrel between the two groups(P>0.05).The length of hospital stay in the combined heart failure group was longer than that in the single myocardial infarction group,and the difference was statistically significant(P<0.05).There was no significant difference in the rate of heart rupture,renal insufficiency,malignant arrhythmia,ventricular aneurysm and embolism,death in the combined heart failure group compared with those in the single myocardial infarction group(P>0.05).Conclusion The clinical characteristics of patients with heart failure after AMI are somewhat different from those of single AMI,and the prognosis of patients with acute myocardial infarction complicated with heart failure is worse and the risk of death is higher.Interventional therapy is a protective factor for prognosis.