急性ST段抬高心肌梗死患者PCI术后心力衰竭的多项因素研究分析

Analysis of Multiple Factors of Heart Failure After PCI in Patients with Acute ST-segment Elevation Myocardial Infarction

目的急性ST段抬高心肌梗死患者经皮冠脉介入治疗(percutaneous coronary intervention,PCI)术后心力衰竭的多项因素研究分析。方法回顾性分析2019年2月至2020年3月收治的103例行PCI术的急性ST段抬高心肌梗死患者的临床资料,根据是否合并心力衰竭将患者分为合并组(39例)和未合并组(64例)。比较两组患者基线资料、入院时的临床特征及PCI相关特征;分析影响急性ST段抬高心肌梗死患者PCI术后心力衰竭的相关危险因素。结果(1)合并组年龄、糖尿病史、心肌梗死史明显高于未合并组(P<0.05);(2)合并组收缩压、舒张压、心绞痛低于未合并组,B型脑利钠肽(brain natriuretic peptide,BNP)高于未合并组(P<0.05);(3)合并组应用主动脉球囊反搏泵(intra-aortic balloon pumping,IABP)少于未合并组、入门-球囊扩张时间长于未合并组(P<0.05);(4)患者糖尿病史、心肌梗死史、心绞痛、应用IABP为影响急性ST段抬高心肌梗死患者PCI术后心力衰竭的相关因素(P<0.05);经非条件多因素Logistic回归模型分析得,糖尿病史(有,OR=2.450)、心肌梗死史(有,OR=2.282)、心绞痛(无,OR=2.344)、应用IABP(无,OR=2.601)为影响急性ST段抬高心肌梗死患者PCI术后心力衰竭的独立危险因素(P<0.05)。结论有糖尿病史、心肌梗死史为影响急性ST段抬高心肌梗死患者PCI术后心力衰竭的独立危险因素,而在急性ST段抬高心肌梗死存在心绞痛以及应用IABP为保护因素,临床需对高危因素予以针对性的预防措施,以改善患者的预后。

Objective To study and analyze multiple factors of heart failure after percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction.Methods The clinical data of 103 patients with acute ST-segment elevation myocardial infarction underwent PCI in our hospital from February 2019 to March 2020 was retrospectively analyzed.The patients were divided into combined groups(n=39)and uncombined groups(n=64)according to whether they were combined with heart failure.The basic data,clinical characteristics and PCI-related characteristics of the two groups were compared;the related risk factors of heart failure after PCI in patients with acute ST-segment elevation myocardial infarction were analyzed.Results(1)The age,history of diabetes,and myocardial infarction in the combined group were significantly higher than those of the uncombined group,and the difference was statistically significant(P<0.05);(2)the systolic blood pressure,diastolic blood pressure,and angina pectoris of the combined group were lower than those of the uncombined group,and brain natriuretic peptide(BNP)was higher than that of the uncombined group,the difference was statistically significant(P<0.05);(3)the use of intra-aortic balloon pumping(IABP)in the combined group was less than that in the uncombined group,and the D2B time was longer than that of the uncombined group,the comparative difference was statistically significant(P<0.05);(4)The history of diabetes,history of myocardial infarction,angina pectoris,and the application of IABP were the related factors affecting heart failure in patients with acute ST-segment elevation myocardial infarction after PCI(P<0.05);after unconditional multivariate logistic regression model analysis,the history of diabetes(yes,OR=2.450),history of myocardial infarction(yes,OR=2.282),angina pectoris(no,OR=2.344),and IABP(no,OR=2.601)were independent risk factors for heart failure after PCI in patients with acute ST-segment elevation myocardial infarction(P<0.05).Conclusion History of diabetes and myocardial infarction are independent risk factors for heart failure after PCI in patients with acute ST-segment elevation myocardial infarction.However,in acute ST-segment elevation myocardial infarction,there is angina pectoris and the application of IABP as a protective factor.Clinical needs high-risk factors should be targeted for preventive measures to improve the prognosis of patients.