急性心肌梗死致心脏破裂的影响因素分析

Analysis on influence factors of cardiac rupture caused by acute myocardial infarction

目的探讨急性心肌梗死(AMI)患者发生心脏破裂(CR)的影响因素。方法回顾性分析我院2005年1月至2016年1月住院确诊的1 438例AMI患者临床资料,根据患者是否合并心脏破裂分为心脏破裂组(n=25)和对照组(n=1 413),运用Logistic回归分析法分析AMI患者并发CR的可能影响因素。结果心脏破裂组患者年龄、女性发生率、前壁梗死率、初发AMI发生率、收缩压、血肌酐均明显高于对照组,血红蛋白、红细胞压积、左心室射血分数及早期成功灌注率均低于对照组,差异均有统计学意义(P<0.05);Logistic回归分析显示,高龄、女性、前壁梗死、合并高血压、贫血、早期未成功灌注、低红细胞压积是AMI患者发生CR的独立影响因素(P<0.05)。结论 AMI并发CR预后极差,其影响因素主要有高龄、女性、前壁梗死、合并高血压、贫血、早期未成功灌注、低红细胞压积等,应积极预防、早期诊断及早期成功再灌注治疗以减少CR的发生。

Objective To explore influence factors of cardiac rupture(CR) in patients with acute myocardial infarction(AMI). Methods The clinical data of 1,438 patients with AMI who admitted in our hospital from January 2005 to January 2016 were retrospectively reviewed. Patients were divided into CR group(25 cases with CR) and control group(1,413 cases without CR). Logistic regression analysis was used to analyze the possible influencing factors of CR in patients with AMI. Results CR group were significantly higher than control group among age, the incidence of CR in females, the incidence of anterior infarction, the incidence of first AMI, systolic pressure and serum creatinine. CR group were significantly lower than control group in hemoglobin, hematokrit, left ventricular ejection fraction and successful early reperfusion, with statistically significant differences(P<0.05). Logistic regression analysis showed that older age, female, anterior infarction, complicated with hypertension, anemia, unsuccessful early perfusion and low hematocrit levels were the independent influence factors of CR in patients with AMI. Conclusion The prognosis of AMI complicated with CR is poor, and the main influencing factors are older age, female, anterior infarction, complicated with hypertension, anemia, unsuccessful early perfusion, low hematocrit levels. Early diagnosis, active prevention and successful reperfusion could reduce the incidence of CR.