急诊经皮冠状动脉介入治疗的老年急性前壁心肌梗死患者住院期间心力衰竭的影响因素研究

摘要

目的：探讨行急诊经皮冠状动脉介入治疗（PCI）的老年急性前壁心肌梗死患者住院期间心力衰竭的影响因素。方法选取玉田县医院2012年1月—2014年1月收治的急性前壁心肌梗死患者177例，均行急诊 PCI，根据患者住院期间心力衰竭发生情况分为心力衰竭组57例和无心力衰竭组120例。回顾性分析两组患者的临床资料（包括一般资料和实验室检查指标），并采用多因素 logistic 回归分析筛选行急诊 PCI 的老年急性前壁心肌梗死患者住院期间心力衰竭的影响因素。结果心力衰竭组患者心率、脉压、肺部感染发生率、恶性心律失常发生率均高于无心力衰竭组，发病至 PCI 时间长于无心力衰竭组，术后 TIMI 血流分级低于无心力衰竭组（ P ＜0.05）；两组患者男性所占比例、收缩压、舒张压、高血压发生率、糖尿病发生率、陈旧性心肌梗死发生率、高脂血症发生率、贫血发生率、吸烟史阳性率比较，差异无统计学意义（ P ﹥0.05）。心力衰竭组患者白细胞计数（ WBC）、尿素氮（ BUN）、空腹血糖（FBG）、醛固酮和超敏 C 反应蛋白（ hs-CRP）水平均高于无心力衰竭组，血红蛋白（ Hb）、低密度脂蛋白胆固醇（LDL-C）和游离三碘甲状腺原氨酸（FT3）水平低于无心力衰竭组（P ＜0.05）；两组患者血小板计数（PLT）、纤维蛋白原（FIB）、血肌酐（Cr）、尿酸（UA）、三酰甘油（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、胰岛素（INS）及血管紧张素Ⅱ（AngⅡ）水平比较，差异无统计学意义（ P ﹥0.05）。多因素 logistic 回归分析结果显示，术后 TIMI 血流分级〔 OR ＝0.126，95% CI（0.034，0.683）〕、发病至 PCI 时间〔 OR ＝0.217，95% CI（0.041，0.970）〕是老年急性前壁心肌梗死患者急诊 PCI 术后心力衰竭的保护因素，恶性心律失常〔 OR ＝1.164，95% CI （1.156，1.284）〕、FBG〔OR ＝1.195，95% CI（1.186，7.036）〕、醛固酮〔 OR ＝1.574，95% CI（1.108，8.356）〕和hs-CRP〔OR ＝1.152，95% CI（1.264，10.278）〕是老年急性前壁心肌梗死患者急诊 PCI 术后心力衰竭的危险因素（P ＜0.05）。结论术后 TIMI 血流分级和早期介入治疗是老年急性前壁心肌梗死患者急诊 PCI 术后住院期间心力衰竭的保护因素，恶性心律失常、FBG、醛固酮和hs-CRP是老年急性前壁心肌梗死患者急诊 PCI 术后住院期间心力衰竭的危险因素，临床上应对合并以上危险因素的患者加以重视。%Objective To investigate the influencing factors of heart failure during hospitalization in elderly acute anterior myocardial infarction patients treated by emergency percutaneous coronary intervention(PCI). Methods A total of 177 elderly patients with acute anterior myocardial infarction were selected in the Yutian County Hospital of Tangshan from January 2012 to January 2014,all of them received emergency PCI after admission,and they were divided into A group(complicated with heart failure,n = 57)and B group(did not complicated with heart failure,n = 120)according to the incidence of heart failure during hospitalization. General information and laboratory examination index were compared between the two groups,and multivariate logistic regression analysis was used to analyze the influencing factors of heart failure during hospitalization in elderly acute anterior myocardial infarction patients treated by emergency PCI. Results Heart rate,pulse pressure,incidence of pulmonary infection and malignant arrhythmia,of A group were statistically significantly higher than those of B group,duration between attack and PCI of A group was statistically significantly longer than that of B groups postoperative TIMI flow grades of A group was statis ically significantly lower than that of B group( P < 0. 05);while no statistically significant differences of proportion of male,systolic blood pressure,diastolic blood pressure,incidence of hypertension,diabetes,old myocardial infarction,hyperlipidaemia or anemia,or positive rate of smoking history was found between the two groups(P ﹥ 0. 05). WBC, BUN,FBG,aldosterone and hs-CRP of A group were statistically significantly higher than those of B group,while Hb,LDL-C and FT3 of A group were statistically significantly lower than those of B group(P < 0. 05);no statistically significant differences of PLT,FIB,Cr,UA,TG,TC,HDL-C,INS or AngⅡ was found between the two groups(P ﹥ 0. 05). Multivariate logistic regression analysis showed that,postoperative TIMI flow grades〔 OR = 0. 126,95% CI( 0. 034,0. 683 )〕 and duration between attack and PCI〔OR = 0. 217,95% CI(0. 041,0. 970)〕were protective factors of heart failure during hospitalization in elderly acute anterior myocardial infarction patients treated by emergency PCI,while malignant arrhythmia〔 OR = 1. 164, 95% CI(1. 156,1. 284)〕,FBG〔OR = 1. 195,95% CI(1. 186,7. 036)〕,aldosterone〔OR = 1. 574,95% CI(1. 108, 8. 356)〕and hs-CRP〔OR = 1. 152,95% CI(1. 264,10. 278)〕 were risk factors of heart failure during hospitalization in elderly acute anterior myocardial infarction patients treated by emergency PCI( P < 0. 05). Conclusion Postoperative TIMI flow grades and duration between attack and PCI were protective factors of heart failure during hospitalization in elderly acute anterior myocardial infarction patients treated by emergency PCI,while malignant arrhythmia,FBG,aldosterone and hs-CRP were risk factors of heart failure during hospitalization in elderly acute anterior myocardial infarction patients treated by emergency PCI,we should pay more attentions to those patients with above risk factors after emergency PCI.