摘要
目的 探讨急性前壁心肌梗死急诊介入治疗患者住院期间心力衰竭发生的危险因素和保护因素.方法 选取2019年1月至2022年12月于黄山首康医院心内科住院期间行急诊介入治疗的急性前壁ST段抬高型心肌梗死患者60例,心肌梗死部位均在前降支近段,根据患者住院期间是否发生心力衰竭分为:心力衰竭组32例和非心力衰竭组28例.将两组患者的临床特征进行比较,并应用多因素Logistic回归分析心力衰竭的危险因素和保护因素.结果 心力衰竭组的收缩压(SBP)、舒张压(DBP)、梗死前心绞痛比例、术后使用ACEI/ARB/ARNI比例、术后TIMI血流分级均低于非心力衰竭亡组(P＜0.05),年龄、糖尿病比例、发病至手术时间(h)、血肌酐(Cr)、血尿酸(UA)、血浆纤维蛋白原(Fib)水平、焦虑量表(SAS)、抑郁量表(SDS)得分心力衰竭组均高于非心力衰竭组(P＜0.05).多因素Logistic回归分析,梗死前心绞痛(OR=0.214,95%CI:0.066～0.700,P=0.011)、术后高TIMI血流分级(OR=0.227,95%CI:0.040～1.287,P=0.016)是患者住院期间心力衰竭的保护因素,焦虑(OR=1.269,95%CI:1.078～1.494,P=0.004)、抑郁(OR=1.127,95%CI:0.985～1.288,P=0.045)、高Fib(OR=4.316,95%CI:1.793～10.387,P=0.001)、高UA(OR=1.013,95%CI:1.005～1.021,P=0.001)、较长的发病至手术时间(OR=1.122,95%CI:1.009～1.248,P=0.033)是患者住院期间心力衰竭的危险因素.结论 存在心肌梗死前心绞痛,术后TIMI血流较好的急性前壁心肌梗死急诊介入治疗患者住院期间发生心力衰竭的风险较低,而焦虑、抑郁、高Fib、高UA、较长的发病至手术时间的患者发生心力衰竭的风险较高.
Abstract
Objective To investigate the risk and protective factors of heart failure(HF)in patients with acute anterior myocardial infarction(AAMI)after emergency percutaneous coronary intervention(PCI)during hospitalization.Methods AAMI patients(n=60),with infarction site in proximal anterior descending branch of coronary artery,undergone PCI during hospitalization were chosen from Department of Cardiology in Huangshan Shoukang Hospital from Jan.2019 to Dec.2022.The patients were divided,according to whether they suffered from HF during hospitalization or not,into HF group(n=32)and non-HF group(n=28).The clinical features were compared between 2 groups,and risk and protective factors of HF were analyzed by using multi-factor Logistic regression analysis.Results The levels of systolic blood pressure(SBP),diastolic blood pressure(DBP),percentages of pre-infarction angina and postoperative administration of ACEI/ARB/ARNI and postoperative TIMI flow grading all were lower(P<0.05),and age,percentage of diabetes,time from disease invasion to operation(h),level of serum creatinine(SCr),blood uric acid(BUA)and fibrinogen(FIB),and scores of self-rating anxiety scale(SAS)and self-rating depressive scale(SDS)all were lower(P<0.05)in HF group than those in non-HF group.The results of multi-factor Logistic regression analysis showed that pre-infarction angina(OR=0.214,95%CI:0.066～0.700,P=0.011)and higher postoperative TIMI flow grade(OR=0.227,95%CI:0.040～1.287,P=0.016)were protective factors of HF during hospitalization,and anxiety(OR=1.269,95%CI:1.078～1.494,P=0.004),depression(OR=1.127,95%CI:0.985～1.288,P=0.045),FIB(OR=4.316,95%CI:1.793～10.387,P=0.001),higher BUA(OR=1.013,95%CI:1.005～1.021,P=0.001)and longer time from disease invasion to operation(OR=1.122,95%CI:1.009～1.248,P=0.033)were risk factors of HF during hospitalization.Conclusion HF risk is lower in AAMI patients undergone emergency PCI with pre-infarction angina and better TIMI flow grade during hospitalization,and HF risk is higher in the patients with anxiety,depression,higher FIB,higher BUA and longer time from disease invasion to operation.
维普
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