急性前壁心肌梗死急诊介入治疗术后发生心力衰竭的影响因素研究

摘要

Objective To investigate the influencing factors of heart failure in patients with acute anterior myocardial infarction treated by emergency PCI. Methods A total of 200 patients with acute anterior myocardial infarction treated by emergency PCI were enrolled in Fuling Centeral Hospital of Chongqing from July 2013 to January 2015,and they were divided into case group(occurred heart failure,n = 61)and control group(did not occurred heart failure,n = 139)according to the incidence of heart failure. Clinical data including demographic characteristics,risk factors of coronary heart disease( including diabetes,hypertension,lesion vessel number,affected lead number,WBC,cTnT,TIMI flow grades after surgery,BNP, LDL-C and attack to surgery duration),LVEF,glomerular filtration rate and drug usage( including ACEI/ ARB and beta -blockers)was compared between the two groups,and binary Logistic regression analysis was used to analyze the influencing factors of heart failure. Results The incidence of diabetes and hypertension,age and blood glucose of case group were statistically significantly higher than those of control group,while incidence of angina pectoris before infarction,blood pressure before surgery,TIMI flow grades after surgery,BNP,LVEF and glomerular filtration rate of case group were statistically significantly lower than those of control group(P < 0. 05). Binary Logistic regression analysis showed that,advanced age〔OR= 1. 102,95% CI(1. 035,1. 174)〕,hypertension〔 OR = 4. 845,95% CI(1. 127,20. 835)〕,increased blood glucose 〔OR = 1. 139,95% CI ( 1. 047,1. 978 )〕, decreased LVEF 〔 OR = 0. 194,95% CI ( 0. 042,0. 965 )〕, decreased glomerular filtration rate〔OR = 0. 141,95% CI(0. 023,0. 301)〕 and worse TIMI flow grades after surgery〔 OR = 0. 113, 95% CI(0. 023,0. 572)〕were influencing factors of heart failure in patients with acute anterior myocardial infarction treated by emergency PCI. Conclusion Acute anterior myocardial infarction patients with advanced age,hypertension,hyperglycaemia, decreased renal function and heart function,worse TIMI flow grades after surgery have high - risk onset of heart failure after emergency PCI.%目的：探讨急性前壁心肌梗死急诊介入治疗术后发生心力衰竭的影响因素。方法选择2013年7月—2015年1月重庆市涪陵中心医院经急诊介入治疗的急性前壁心肌梗死患者200例，根据患者术后是否发生心力衰竭分为心力衰竭组61例和非心力衰竭组139例。回顾性分析患者的临床资料，记录人口学特征、冠心病危险因素〔糖尿病、高血压、病变血管支数、受累导联数、白细胞计数（ WBC）、肌钙蛋白 T、术后 TIMI 血流分级、B 型利脑肽（BNP）、低密度脂蛋白胆固醇（LDL-C）及发病至手术时间等〕、左心室射血分数（LVEF）、肾小球滤过率及目前用药情况〔他汀类药物、血管紧张素转换酶抑制剂（ACEI）/血管紧张素受体拮抗剂（ARB）及β受体阻滞剂〕。采用二分类 Logistic 回归分析筛选心力衰竭的影响因素。结果心力衰竭组患者糖尿病发生率、高血压发生率、年龄、血糖高于非心力衰竭组，梗死前心绞痛发生率、术前血压、术后 TIMI 血流分级、BNP、LVEF 及肾小球滤过滤低于非心力衰竭组（P ＜0.05）。二分类 Logisitic 回归分析结果显示，高龄〔OR ＝1.102，95% CI（1.035，1.174）〕、高血压〔OR ＝4.845，95% CI（1.127，20.835）〕、高血糖〔OR ＝1.139，95% CI（1.047，1.978）〕、低 LVEF〔OR ＝0.194，95% CI （0.042，0.965）〕、低肾小球滤过率〔OR ＝0.141，95% CI（0.023，0.301）〕及术后 TIMI 血流分级差〔OR ＝0.113，95% CI（0.023，0.572）〕是急性前壁心肌梗死急诊介入治疗术后发生心力衰竭的影响因素。结论高龄、高血压、高血糖、术前肾功能和心功能低下、术后 TIMI 血流分级差的急性前壁心肌梗死患者急诊介入治疗术后易发生心力衰竭。