急性心肌梗死患者院内消化道出血的危险因素分析

Risk factors of in-hospital gastrointestinal bleeding for hospitalized patients with acute myocardial infarction

目的:分析导致急性心肌梗死(acute myocardial infarction,AMI)患者院内消化道出血的危险因素。方法:回顾性纳入首都医科大学附属北京安贞医院住院诊治的AMI患者,根据是否院内出现消化道出血分为院内消化道出血组和未消化道出血组,比较两组患者临床特征及实验室化验检查结果,寻找可能影响院内消化道出血的危险因素。结果:共纳入患者3207例,204例(6.4%)AMI患者住院期间消化道出血,单因素分析结果提示BMI低、肌酐升高,HGB降低,既往存在消化道溃疡史、消化道出血史及心肺复苏术后史,抗血小板+抗凝+院外溶栓治疗、抗血小板+抗凝+我院溶栓治疗、主动脉球囊反搏(intra aortic ballon pump,IABP)及临时起搏器与院内消化道出血有关,进一步的多因素Logistic回归分析提示抗血小板+抗凝+外院溶栓治疗、IABP、消化道出血史及肌酐升高是AMI患者院内消化道出血的危险因素。结论:抗血小板+抗凝+外院溶栓治疗、IABP、消化道出血史及肌酐升高是AMI患者院内消化道出血的危险因素。

Objective:To evaluate the risk factors of in-hospital gastrointestinal bleeding for hospitalized patients with acute myocardial infarction(AMI).Methods:Hospitalized patients who were diagnosed with AMI were retrospectively enrolled in Beijing Anzhen Hospital,Capital Medical University.According to the occurrence of gastrointestinal bleeding,the patients were divided into AMI with gastrointestinal bleeding group and AMI without gastrointestinal bleeding group,relative clinial information as well as laboratory tests results were analyzed and compared between the two groups,to evaluate risk factors that may affect gastrointestinal bleeding.Results:A total of 3207 patients were finally enrolled,204 of them were gastrointestinal bleeding during hospitalization,univiarable analysis revealed that low BMI,creatinine elevation,hypochromemia,with history of gastrointestinal ulcer,gastrointestinal bleeding and cardiopulmonary resuscitation,antiplatelet+anticoa gulant+thrombolytic(outside our hospital)therapy,antiplatelet+anticoagulant+thrombolytic(our hospital)therapy,intra aortic ballon pump(IABP)and temporary pacemaker were used,all above were related to gastrointestinal bleeding in hospital.Further Logistic analyse demonstrated that antiplatelet+anticoagulant+thrombolytic(outside our hospital)therapy(IABP)history of gastrointestinal bleeding and creatinine elevation were the independent risk factors for in-hospital gastrointestinal bleeding for patients with AMI.Conclusions:antiplatelet+anticoagula nt+thrombolytic(outside our hospital)therapy(IABP)history of gastrointestinal bleeding and creatinine elevation were the independent risk factors for in-hospital gastrointestinal bleeding for patients with AMI.