急性ST段抬高型心肌梗死患者再灌注治疗预后的影响因素
|
摘要
目的探讨急性ST段抬高型心肌梗死(STEMI)患者再灌注治疗预后的影响因素。方法选取2012年1月～2015年1月于我院行再灌注治疗的126例STEMI患者作为研究对象,采用回顾性分析所有患者的临床及随访资料,根据其资料结果记录所有患者的性别、年龄、疾病史等一般临床资料,疾病情况、血红蛋白等相关临床指标水平以及再灌注治疗后的预后效果,并比较不同预后效果患者间上述资料的差异性。分析影响再灌注治疗STEMI患者预后的因素。结果 126例STEMI患者经再灌注治疗后预后好106例(84.13%),预后差20例(15.87%);年龄≥60岁的STEMI患者其女性和糖尿病比例以及心功能killip分级较高,而吸烟和饮酒患者较少,血红蛋白水平较低,预后较差(P<0.05);中、重度贫血患者其女性、吸烟、糖尿病比例和年龄及心功能能killip分级均高于非贫血和轻度贫血者,且前两者预后更差比较差异间均具有统计学意义(P<0.05);既往存在糖尿病病史,有吸烟、喝酒习惯,心功能killip分级过高、血脂异常以及年龄≥60岁和中、重度贫血的STEMI患者经再灌注治疗后其预后较差(P<0.05);经非条件多因素Lgistic回归模型分析显示,killip分级过高、血脂异常以及年龄≥60岁和中、重度贫血是影响STEMI再灌注治疗预后效果的独立危险因素(P<0.05)。结论 STEMI患者经再灌注治疗后的预后效果尚可,年龄≥60岁和中、重度贫血等均为影响STEMI再灌注治疗预后效果的独立危险因素,可将其联合作为临床上评估STEMI患者经再灌注治疗预后效果的有效指标。
Objective To investigate the effect of age and hemoglobin on the prognosis of patients with ST-segment elevation acute myocardial infarction(STEMI) after reperfusion therapy. Methods 126 patients with STEMI treated with reperfusion in our hospital from January 2012 to January 2015 were enrolled. The clinical and follow-up data of all patients were analyzed retrospectively. According to the results of the data, the general clinical data such as gender, age, and disease history of all patients, the related clinical indicators such as disease situation and hemoglobin and prognostic effects after reperfusion therapy were recorded. The differences in the above data between patients with different prognostic effects were compared.Results In 126 patients with STEMI, 106 patients had a good prognosis after reperfusion treatment, accounting for 84.13%, and the prognosis of 20 patients was poor, accounting for 15.87%. In STEMI patients who was more than 60 years, the proportion of women and diabetes was low and the killip classification of cardiac function was low, while there were fewer smokers and alcoholics, and they had lower hemoglobin level and poorer prognostic effects(P<0.05). The proportion of women, smoking and diabetes, age, and the killip classification of cardiac function in patients with moderate to severe anemia were significantly higher than that in patients with no anemia and mild anemia, and the difference in worse prognosis of the former two groups was statistically significant(P<0.05). STEMI patients who had a history of diabetes, and habits of smoking, drinking, had exorbitant killip classification of cardiac function,dyslipidemia and moderate to severe anemia,and was more than 60 years, had a poor prognosis after reperfusion(P<0.05). The unconditional multivariate Lgistic regression model showed that the exorbitant killip classification, dyslipidemia,age more than 60 years old and moderate to severe anemia were independent risk factors for the prognostic effects of STEMI after reperfusion(P<0.05). Conclusion The prognostic effects of STEMI patients after reperfusion therapy is acceptable. However, age more than 60 years old and the presence of moderate to severe anemia are independent risk factors affecting the prognostic effects of STEMI after reperfusion therapy. They can be combined as an effective indicator for clinical evaluation of the prognostic effect in STEMI patients after reperfusion therapy.
Objective To investigate the effect of age and hemoglobin on the prognosis of patients with ST-segment elevation acute myocardial infarction(STEMI) after reperfusion therapy. Methods 126 patients with STEMI treated with reperfusion in our hospital from January 2012 to January 2015 were enrolled. The clinical and follow-up data of all patients were analyzed retrospectively. According to the results of the data, the general clinical data such as gender, age, and disease history of all patients, the related clinical indicators such as disease situation and hemoglobin and prognostic effects after reperfusion therapy were recorded. The differences in the above data between patients with different prognostic effects were compared.Results In 126 patients with STEMI, 106 patients had a good prognosis after reperfusion treatment, accounting for 84.13%, and the prognosis of 20 patients was poor, accounting for 15.87%. In STEMI patients who was more than 60 years, the proportion of women and diabetes was low and the killip classification of cardiac function was low, while there were fewer smokers and alcoholics, and they had lower hemoglobin level and poorer prognostic effects(P<0.05). The proportion of women, smoking and diabetes, age, and the killip classification of cardiac function in patients with moderate to severe anemia were significantly higher than that in patients with no anemia and mild anemia, and the difference in worse prognosis of the former two groups was statistically significant(P<0.05). STEMI patients who had a history of diabetes, and habits of smoking, drinking, had exorbitant killip classification of cardiac function,dyslipidemia and moderate to severe anemia,and was more than 60 years, had a poor prognosis after reperfusion(P<0.05). The unconditional multivariate Lgistic regression model showed that the exorbitant killip classification, dyslipidemia,age more than 60 years old and moderate to severe anemia were independent risk factors for the prognostic effects of STEMI after reperfusion(P<0.05). Conclusion The prognostic effects of STEMI patients after reperfusion therapy is acceptable. However, age more than 60 years old and the presence of moderate to severe anemia are independent risk factors affecting the prognostic effects of STEMI after reperfusion therapy. They can be combined as an effective indicator for clinical evaluation of the prognostic effect in STEMI patients after reperfusion therapy.
引文
[1] 袁霄, 王瑞钰, 沈健,等. 体质量指数与急性ST段抬高型心肌梗死患者预后的相关性研究[J]. 重庆医学, 2017, 46(27):3782-3785.
[2] 李超, 胡大一, 李洁,等. 性别对急性ST段抬高心肌梗死患者预后的影响[J]. 心肺血管病杂志, 2015, 34(5):339-343.
[3] 阮焕钧, 徐洪涛, 李田昌,等. 急诊PCI术前高密度脂蛋白胆固醇水平对急性ST段抬高型心肌梗死患者预后的影响[J]. 解放军医学院学报, 2016, 37(1):30-33.
[4] 王辉, 刘震宇, 张抒扬,等. 高龄急性ST段抬高型心肌梗死患者行直接经皮冠状动脉介入治疗的近期预后[J]. 中华老年心脑血管病杂志, 2015, 17(10):1028-1032.
[5] 张涛, 杨艳敏, 朱俊,等. 血清钠水平对急性ST段抬高型心肌梗死患者近期预后的预测价值[J]. 中国循环杂志, 2017, 32(8):542-544.
[6] 王丹丹, 李秀, 王蔓蔓,等. 瑞舒伐他汀治疗对急性ST段抬高型心肌梗死患者短期预后的影响[J]. 天津医药, 2017, 45(3):314-317.
[7] Li X, Li B, Gao J, et al. Influence of angiographic spontaneous coronary reperfusion on long-term prognosis in patients with ST-segment elevation myocardial infarction[J]. Oncotarget, 2017, 8(45):79767-79774.
[8] 王志清, 陈梅贤, 刘东林,等. 预防性冠状动脉内注射尼可地尔对急性ST 段抬高型心肌梗死介入治疗后心肌血流灌注及预后的影响[J]. 中华心血管病杂志, 2017, 45(1):26-33.
[9] 贾宁, 冯艳, 王明生,等. 入院糖化血红蛋白对接受直接经皮冠状动脉介入治疗的急性心肌梗死患者长期预后的影响[J]. 中国心血管杂志, 2015,19(1):8-12.
[10] 张优, 高传玉, 段广才,等. 河南省80岁以上急性ST段抬高型心肌梗死患者的早期再灌注治疗情况和住院病死率[J]. 中国急救医学, 2017, 37(8):584-586.
[11] 李超, 胡大一, 李莉,等. 肾功能不全对急性心肌梗死患者长期预后影响的性别差异[J]. 中华内科杂志, 2015, 54(12):1007-1012.
[12] 赵蓓, 刘利峰, 刘瑛琪,等. 冠状动脉内小剂量尿激酶溶栓联合支架植入对急性ST段抬高型心肌梗死患者心肌灌注及短期预后的影响[J]. 解放军医学杂志, 2015, 40(8):661-665.
[13] 何培源, 杨进刚, 许海燕,等. 不同年龄段ST段抬高型心肌梗死患者的不同再灌注治疗与院内预后的关系[J]. 中国循环杂志, 2017, 32(1):368-370.
[14] 王俊岭, 曹雪滨, 毛继康,等. 急性ST段抬高型心肌梗死患者行急诊介入治疗延误的原因分析[J]. 中国循证心血管医学杂志, 2015,7(3):404-404.
[15] 张优, 高传玉, 段广才,等. 河南省不同级别医院急性ST段抬高型心肌梗死患者早期再灌注治疗现状调查[J]. 中华心血管病杂志, 2015, 43(10):858-862.
[16] 杨进刚, 许海燕, 高晓津,等. 中国省、市和县级医院急性ST段抬高型心肌梗死住院患者再灌注治疗和二级预防用药分析[J]. 中国循环杂志, 2017, 32(1):12-16.
[17] 黄文军, 闫博宇, 叶君明,等. 缺血后适应对急性心肌梗死急症介入治疗患者心肌灌注及预后的影响[J]. 介入放射学杂志, 2015,23(7):571-574.
[18] 张军玲. 区域协同救治对急性ST段抬高型心肌梗死病人再灌注时间及预后的影响[J]. 中西医结合心脑血管病杂志, 2016, 14(22):2672-2675.
[19] Shacham Y, Galoz A, Leshemrubinow E, et al. Admission Glucose Levels and the Risk of Acute Kidney Injury in Nondiabetic ST Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention.[J]. Cardiorenal Medicine, 2015, 5(3):191-198.
[20] 顾永林, 郭俊林, 蒋灵霓,等. 急性ST段抬高性心肌梗死患者再灌注治疗后心肌损伤指标动态变化的价值[J]. 中国循证心血管医学杂志, 2016, 8(9):1119-1121.
[21] 李智博, 王婧, 刘斌,等. 法舒地尔对急性ST段抬高型心肌梗死患者急诊PCI术中无复流现象及内皮细胞功能的影响[J]. 中国实验诊断学, 2016, 20(7):1126-1127.
[22] 张大鹏, 王乐丰, 王红石,等. 替罗非班对未行早期再灌注治疗急性ST段抬高型心肌梗死患者的疗效[J]. 中华内科杂志, 2016, 55(4):273-277.
[23] 吴玉营, 柴仁贵, 赵培华,等. 急性ST段抬高型心肌梗死患者急诊介入治疗术中血栓抽吸的临床应用[J]. 中国综合临床, 2016, 32(7):606-610.
[24] 卢青, 丁世芳, 陈志楠,等. 瑞舒伐他汀不同预处理对急性ST段抬高型心肌梗死后患者冠状动脉介入治疗后心肌再灌注及相关因素的影响[J]. 中国心脏起搏与心电生理杂志, 2016,34(6):517-521.
[25] 罗松平, 朱虹, 段宝民. 急性心肌梗死再灌注失败预后临床评估[J]. 临床急诊杂志, 2016,16(9):688-691.
[26] 郭文玲, 冯巧爱, 吴磊,等. 急性ST段抬高型心肌梗死早期再灌注治疗后心功能的评价[J]. 中西医结合心脑血管病杂志, 2015,12(5):642-643.
[27] 梁磊, 张彬, 李萍,等. 急救干预对急性ST段抬高型心肌梗死预后的影响[J]. 内科理论与实践, 2016,10(1):24-27.
[28] 张朝霞. 疏血通联合参麦注射液对老年急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗后再灌注损伤的预防作用[J]. 实用心脑肺血管病杂志, 2017, 25(1):84-86.
[29] Gelbard, Martin. Predictors of No-Reflow Phenomenon in Young Patients With Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention[J]. Angiology, 2016, 234(2):683-689.
[30] 刘如晨, 徐争鸣, 李田昌. 血栓抽吸在急性ST段抬高型心肌梗死中的研究进展[J]. 心血管病学进展, 2016, 37(3):240-243.
[2] 李超, 胡大一, 李洁,等. 性别对急性ST段抬高心肌梗死患者预后的影响[J]. 心肺血管病杂志, 2015, 34(5):339-343.
[3] 阮焕钧, 徐洪涛, 李田昌,等. 急诊PCI术前高密度脂蛋白胆固醇水平对急性ST段抬高型心肌梗死患者预后的影响[J]. 解放军医学院学报, 2016, 37(1):30-33.
[4] 王辉, 刘震宇, 张抒扬,等. 高龄急性ST段抬高型心肌梗死患者行直接经皮冠状动脉介入治疗的近期预后[J]. 中华老年心脑血管病杂志, 2015, 17(10):1028-1032.
[5] 张涛, 杨艳敏, 朱俊,等. 血清钠水平对急性ST段抬高型心肌梗死患者近期预后的预测价值[J]. 中国循环杂志, 2017, 32(8):542-544.
[6] 王丹丹, 李秀, 王蔓蔓,等. 瑞舒伐他汀治疗对急性ST段抬高型心肌梗死患者短期预后的影响[J]. 天津医药, 2017, 45(3):314-317.
[7] Li X, Li B, Gao J, et al. Influence of angiographic spontaneous coronary reperfusion on long-term prognosis in patients with ST-segment elevation myocardial infarction[J]. Oncotarget, 2017, 8(45):79767-79774.
[8] 王志清, 陈梅贤, 刘东林,等. 预防性冠状动脉内注射尼可地尔对急性ST 段抬高型心肌梗死介入治疗后心肌血流灌注及预后的影响[J]. 中华心血管病杂志, 2017, 45(1):26-33.
[9] 贾宁, 冯艳, 王明生,等. 入院糖化血红蛋白对接受直接经皮冠状动脉介入治疗的急性心肌梗死患者长期预后的影响[J]. 中国心血管杂志, 2015,19(1):8-12.
[10] 张优, 高传玉, 段广才,等. 河南省80岁以上急性ST段抬高型心肌梗死患者的早期再灌注治疗情况和住院病死率[J]. 中国急救医学, 2017, 37(8):584-586.
[11] 李超, 胡大一, 李莉,等. 肾功能不全对急性心肌梗死患者长期预后影响的性别差异[J]. 中华内科杂志, 2015, 54(12):1007-1012.
[12] 赵蓓, 刘利峰, 刘瑛琪,等. 冠状动脉内小剂量尿激酶溶栓联合支架植入对急性ST段抬高型心肌梗死患者心肌灌注及短期预后的影响[J]. 解放军医学杂志, 2015, 40(8):661-665.
[13] 何培源, 杨进刚, 许海燕,等. 不同年龄段ST段抬高型心肌梗死患者的不同再灌注治疗与院内预后的关系[J]. 中国循环杂志, 2017, 32(1):368-370.
[14] 王俊岭, 曹雪滨, 毛继康,等. 急性ST段抬高型心肌梗死患者行急诊介入治疗延误的原因分析[J]. 中国循证心血管医学杂志, 2015,7(3):404-404.
[15] 张优, 高传玉, 段广才,等. 河南省不同级别医院急性ST段抬高型心肌梗死患者早期再灌注治疗现状调查[J]. 中华心血管病杂志, 2015, 43(10):858-862.
[16] 杨进刚, 许海燕, 高晓津,等. 中国省、市和县级医院急性ST段抬高型心肌梗死住院患者再灌注治疗和二级预防用药分析[J]. 中国循环杂志, 2017, 32(1):12-16.
[17] 黄文军, 闫博宇, 叶君明,等. 缺血后适应对急性心肌梗死急症介入治疗患者心肌灌注及预后的影响[J]. 介入放射学杂志, 2015,23(7):571-574.
[18] 张军玲. 区域协同救治对急性ST段抬高型心肌梗死病人再灌注时间及预后的影响[J]. 中西医结合心脑血管病杂志, 2016, 14(22):2672-2675.
[19] Shacham Y, Galoz A, Leshemrubinow E, et al. Admission Glucose Levels and the Risk of Acute Kidney Injury in Nondiabetic ST Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention.[J]. Cardiorenal Medicine, 2015, 5(3):191-198.
[20] 顾永林, 郭俊林, 蒋灵霓,等. 急性ST段抬高性心肌梗死患者再灌注治疗后心肌损伤指标动态变化的价值[J]. 中国循证心血管医学杂志, 2016, 8(9):1119-1121.
[21] 李智博, 王婧, 刘斌,等. 法舒地尔对急性ST段抬高型心肌梗死患者急诊PCI术中无复流现象及内皮细胞功能的影响[J]. 中国实验诊断学, 2016, 20(7):1126-1127.
[22] 张大鹏, 王乐丰, 王红石,等. 替罗非班对未行早期再灌注治疗急性ST段抬高型心肌梗死患者的疗效[J]. 中华内科杂志, 2016, 55(4):273-277.
[23] 吴玉营, 柴仁贵, 赵培华,等. 急性ST段抬高型心肌梗死患者急诊介入治疗术中血栓抽吸的临床应用[J]. 中国综合临床, 2016, 32(7):606-610.
[24] 卢青, 丁世芳, 陈志楠,等. 瑞舒伐他汀不同预处理对急性ST段抬高型心肌梗死后患者冠状动脉介入治疗后心肌再灌注及相关因素的影响[J]. 中国心脏起搏与心电生理杂志, 2016,34(6):517-521.
[25] 罗松平, 朱虹, 段宝民. 急性心肌梗死再灌注失败预后临床评估[J]. 临床急诊杂志, 2016,16(9):688-691.
[26] 郭文玲, 冯巧爱, 吴磊,等. 急性ST段抬高型心肌梗死早期再灌注治疗后心功能的评价[J]. 中西医结合心脑血管病杂志, 2015,12(5):642-643.
[27] 梁磊, 张彬, 李萍,等. 急救干预对急性ST段抬高型心肌梗死预后的影响[J]. 内科理论与实践, 2016,10(1):24-27.
[28] 张朝霞. 疏血通联合参麦注射液对老年急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗后再灌注损伤的预防作用[J]. 实用心脑肺血管病杂志, 2017, 25(1):84-86.
[29] Gelbard, Martin. Predictors of No-Reflow Phenomenon in Young Patients With Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention[J]. Angiology, 2016, 234(2):683-689.
[30] 刘如晨, 徐争鸣, 李田昌. 血栓抽吸在急性ST段抬高型心肌梗死中的研究进展[J]. 心血管病学进展, 2016, 37(3):240-243.