急性心肌梗死急诊经皮冠状动脉介入术后低血压的危险因素
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摘要
目的探讨急性心肌梗死(AMI)患者行经皮冠状动脉介入治疗术(PCI)后发生低血压的危险因素。方法收集我院2013年1月至2015年8月300例行急诊经皮冠状动脉介入术的患者资料,根据术后是否出现低血压症状分为低血压组和非低血压组,记录比较2组患者的一般情况、相关临床指标,并对危险因素进行logistics归回分析。结果 2组患者的一般情况比较,低血压组有心绞痛史少于非低血压组,且差异有统计学意义(P<0.05),其余一般情况比较,差异均无统计学意义(P>0.05)。2组患者LDL-C比较,差异无统计学意义(P>0.05);CK-MB峰值、下壁心肌梗死及右心室心肌梗死的比较,差异有统计学意义(P<0.05)。2组患者冠状动脉病变情况中多支病变的比较,差异无统计学意义(P>0.05),其余情况比较,差异具有统计学意义(P<0.05)。结论 CK-MB峰值、下壁心肌梗死、右心室心肌梗死及术后TIMI血流小于2级均为患者PCI术后低血压的危险因素。
Objective To explore the risk factors of hypotension of patient with acute myocardial infraction( AMI) after emergency percutaneous coronary intervention( PCI). Methods The data of 300 patients with AMI who received PCI in our hospital from January 2015 to August 2015 were collected. According to the symptom of hypotension,the patients were divided into hypotension group and normal group. The general information and relative clinical data were recorded and compared. The risk factors were analyzed by logistics regressive analysis.Results The incidence of previous angina of hypotension group was lower than that of normal group,the difference was significant(P < 0. 05),there was no difference in other general information between two groups( P > 0. 05). There was no difference in level of LDL-C between two groups( P > 0. 05). And the differences in peak value of CK-MB,inferior wall or right ventricular infarction were statistical significance(P < 0. 05). There was no significant difference in multi-vessel lesions(P > 0. 05),and the difference in others of coronary artery lesion between two groups was statistical significance( P < 0. 05). Conclusion The peak value of CK-MB,inferior wall or right ventricular infarction and TIMI < 2 after PCI can increase the possibility of hypotension after PCI,and angina pectoris before infarction can reduce the incidence of hypotension after PCI.
Objective To explore the risk factors of hypotension of patient with acute myocardial infraction( AMI) after emergency percutaneous coronary intervention( PCI). Methods The data of 300 patients with AMI who received PCI in our hospital from January 2015 to August 2015 were collected. According to the symptom of hypotension,the patients were divided into hypotension group and normal group. The general information and relative clinical data were recorded and compared. The risk factors were analyzed by logistics regressive analysis.Results The incidence of previous angina of hypotension group was lower than that of normal group,the difference was significant(P < 0. 05),there was no difference in other general information between two groups( P > 0. 05). There was no difference in level of LDL-C between two groups( P > 0. 05). And the differences in peak value of CK-MB,inferior wall or right ventricular infarction were statistical significance(P < 0. 05). There was no significant difference in multi-vessel lesions(P > 0. 05),and the difference in others of coronary artery lesion between two groups was statistical significance( P < 0. 05). Conclusion The peak value of CK-MB,inferior wall or right ventricular infarction and TIMI < 2 after PCI can increase the possibility of hypotension after PCI,and angina pectoris before infarction can reduce the incidence of hypotension after PCI.
引文
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[14]Sever P.Hypotension and ischaemic stroke associated with aliskiren in the ALTITUDE trial:sensitisation of the Bezold-Jarisch reflex?[J].JRenin Angiotensin Aldosterone Syst,2013,14(1):1-2.doi:10.1177/1470320312468832.
[15]Ye J,Chen Q,Yang X,et al.Aging might augment reactive oxygen species(ROS)formation and affect reactive nitrogen species(RNS)level after myocardial ischemia/reperfusion in both humans and rats[J].Age(Dordr),2013,35(4):1017-1026.doi:10.1007/s11357-012-9421-y.
[2]Dalen JE,Alpert JS,Goldberg RJ,et al.The epidemic of the 20(th)century coronary heart disease[J].Am J Med,2014,127(9):807-812.doi:10.1016/j.amjmed.2014.04.015.
[3]戴成久.急性心肌梗死治疗进展[J].河北联合大学学报(医学版),2011,13(6):779-780.doi:10.3969/j.issn.1008-6633.2011.06.032.
[4]Gorenoi V,Hagen A.Percutaneous coronary intervention in addition to optimal medical therapy for stabile coronary artery disease-a systematic review and meta-analysis[J].Dtsch Med Wochenschr,2014,139(20):1039-1045.doi:10.1055/s-0034-1369879.
[5]Kan J,Chen F.Value of propensity score method in percutaneous coronary intervention studies[J].Zhonghua Xin Xue Guan Bing Za Zhi,2014,42(1):76-79.
[6]胡怀岭,李群,姜椿法,等.急诊经皮冠状动脉介入术治疗急性心肌梗死患者术后低血压危险因素[J].临床荟萃,2015,30(1):13-16.doi:10.3969/j.issn.1004-583X.2015.01.003.
[7]Jespersen L,Abildstrom SZ,Pena A,et al.Predictive value of the corrected TIMI frame count in patients with suspected angina pectoris but no obstructive coronary artery disease at angiography[J].Clin Res Cardiol,2014,103(5):381-387.doi:10.1007/s00392-014-0665-7.
[8]White CM,Chow MS,Fan C,et al.Efficacy of intravenous granisetron in suppressing the bradycardia and hypotension associated with a rabbit model of the Bezold-Jarisch reflex[J].J Clin Pharmacol,1998,38(2):172-177.
[9]周亚峰,姚佳璐,钱晓东,等.急性心肌梗死患者急诊经皮冠状动脉成形术后低血压的相关因素分析[J].中华临床医师杂志(电子版),2014,8(10):1804-1808.doi:10.3969/cma.j.issn.1674-0785.2014.10.001.
[10]Ho E,Karimi Galougahi K,Liu CC,et al.Biological markers of oxidative stress:applications to cardiovascular research and practice[J].Redox Biol,2013,1(1):483-491.doi:10.1016/j.redox.2013.07.006.
[11]Li K,Zhang W,Fang H,et al.Superoxide flashes reveal novel properties of mitochondrial reactive oxygen species excitability in cardiomyocytes[J].Biophys J,2012,102(5):1011-1021.doi:10.1016/j.bpj.2012.01.044.
[12]Dragasis S,Bassiakou E,Iacovidou N,et al.The role of opioid receptor agonists in ischemic preconditioning[J].Eur J Pharmacol,2013,720(1/3):401-408.doi:10.1016/j.ejphar.2013.10.001.
[13]Zhang JQ,Wang Q,Xue FS,et al.Ischemic preconditioning produces more powerful anti-inflammatory and cardioprotective effects than limb remote ischemic postconditioning in rats with myocardial ischemiareperfusion injury[J].Chin Med J(Engl),2013,126(20):3949-3955.
[14]Sever P.Hypotension and ischaemic stroke associated with aliskiren in the ALTITUDE trial:sensitisation of the Bezold-Jarisch reflex?[J].JRenin Angiotensin Aldosterone Syst,2013,14(1):1-2.doi:10.1177/1470320312468832.
[15]Ye J,Chen Q,Yang X,et al.Aging might augment reactive oxygen species(ROS)formation and affect reactive nitrogen species(RNS)level after myocardial ischemia/reperfusion in both humans and rats[J].Age(Dordr),2013,35(4):1017-1026.doi:10.1007/s11357-012-9421-y.