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经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)以其微创、安全性高、疗程短等优点已成为治疗急性下壁心肌梗死的主要手段,其通过早期开通心外膜闭塞血管、挽救濒死心肌,重建血液循环[1-2]。然而,部分急性下壁心肌梗死病人在急诊PCI术中可能发生无复流现象,使缺血的心肌组织未能有效地恢复灌注,严重降低了急诊PCI的近期和远期临床疗效,增加术中并发症及病死率[3-4]。因此,通过及早预测病人急诊PCI术中发生无复流的危险因素,并选择适当的治疗方法,对于降低无复流的发生具有重要意义。本研究回顾性总结了2011年12月至2015年8月我科收治的急性下壁心肌梗死126例病人在急诊PCI中无复流现象的发生情况,并对无复流病人的临床因素进行相关分析,寻找可以有效预测无复流的危险因素,为个体化解决急诊PCI术中无复流提供临床依据。
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本研究纳入126例急性下壁心肌梗死病人均成功进行急诊PCI治疗,其中有16例发生无复流,发生率12.70%。与正常组相比,无复流组在糖尿病、发病至急诊PCI时间、术前TIMI血流分级、术前收缩压、肌钙蛋白T峰值等差异均有统计学意义(P<0.05~P<0.01)(见表 1)。
一般资料 正常组
(n = 110)无复流组
(n= 16)t P 年龄/岁 61.94±11.35 62.88±12.18 0.25 >0.05 男/女 75/35 9/7 0.89△ >0.05 BMI/(kg/m2) 27.53±2.84 26.92±3.15 0.65 >0.05 糖尿病 40(36.36) 11(68.75) 6.08△ <0.05 高脂血症 49(44.55) 7(43.75) 0.00△ >0.05 高血压 66(67.74) 7(43.75) 1.51△ >0.05 有心肌梗死病史 21(19.09) 3(18.75) 0.10△ >0.05 饮酒 62(56.36) 10(62.50) 0.21△ >0.05 吸烟 54(27.42) 11(10.97) 2.16△ >0.05 发病至急诊PCI时间/h 5.42±0.47 7.15±1.13 4.81# <0.01 术前TIMI血流分级≤1级 64(58.18) 14(87.50) 5.09 <0.05 术前收缩压/mmHg 121.34±18.26 103.68±20.74 2.90 <0.01 术前舒张压/mmHg 64.95±15.68 67.23±17.93 0.44 >0.05 肌钙蛋白T峰值/(nmol/L) 1.46±0.35 3.72±1.31 5.44# <0.01 白细胞计数/(10-9/L) 10.03±2.84 9.55±2.84 0.51 >0.05 狭窄程度/% 78.28±7.17 80.40±8.69 0.88 >0.05 病变长度/mm 27.92±3.43 27.15±2.86 0.69 >0.05 支架管径/mm 3.06±0.44 3.18±0.42 0.83 >0.05 左室射血分数/% 44.25±8.68 47.93±8.93 1.28 >0.05 △示χ2值;#示t′值 表 1 一般资料比较[n; 百分率(%)]
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对研究对象进行多因素logistic回归分析,选择糖尿病、发病至急诊PCI时间、术前TIMI血流分级、术前收缩压、肌钙蛋白T峰值等单因素分析有意义自变量,并将是否出现无复流作为因变量。自变量赋值见表 2。结果显示, 急性下壁心肌梗死病人急诊PCI术中出现无复流的危险因素为糖尿病、发病至急诊PCI时间、术前TIMI血流分级(≤1级)、肌钙蛋白T峰值和术前收缩压(P < 0.05~P < 0.01)(见表 3)。
自变量 赋值方式 糖尿病 否=0,是=1 发病至急诊PCI时间 < 6 h=0,6~12 h=1,>12 h=2 术前TIMI血流分级(≤1级) 是=0,否=1 术前收缩压 ≥110 mmHg = 0,< 110 mmHg=1 肌钙蛋白T峰值 ≤2.0 nmol/L=0,>2 nmol/L=1 表 2 自变量赋值
因素 B Waldχ2 OR 95%CI P 常数项 -2.203 0.048 5.283 2.861~9.460 < 0.05 糖尿病 1.119 3.658 1.647 1.242~1.845 < 0.05 发病至急诊PCI时间 3.132 6.883 5.281 2.782~10.018 < 0.01 术前TIMI血流分级(≤1级) 2.083 2.682 2.735 1.040~3.062 < 0.05 术前收缩压 6.162 3.442 1.844 1.153~3.638 < 0.05 肌钙蛋白T峰值 2.105 5.353 1.064 1.019~1.233 < 0.05 表 3 急性下壁心肌梗死病人急诊PCI术中出现无复流的危险因素logistic分析
急性下壁心肌梗死病人急诊PCI术中出现无复流的相关危险因素探讨
Analysis of the related risk factor of no-reflow in patients with acute inferior myocardial infarction during PCI
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摘要:
目的探讨急性下壁心肌梗死病人直接经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)中无复流的发生情况及其危险因素。 方法收集126例急性下壁心肌梗死行急诊PCI治疗病人的病历资料,采用logistic回归分析无复流发生的相关危险因素。 结果126例急性下壁心肌梗死病人均成功进行急诊PCI治疗,其中有16例发生无复流,发生率12.70%。多因素logistic回归分析结果显示,急性下壁心肌梗死病人急诊PCI术中出现无复流的危险因素为糖尿病(OR=1.647,95%CI:1.242~1.845,P < 0.05)、发病至急诊PCI时间(OR=5.281,95%CI:2.782~10.018,P=0.002)、术前TIMI血流分级(≤1级)(OR=2.735,95%CI:1.040~3.062,P=0.020)和术前收缩压(OR=1.844,95%CI:1.153~3.638,P=0.015)。 结论无复流在急性下壁心肌梗死病人急诊PCI术中具有较高的发生率,应对无复流发生的相关影响因素采取有效的预防措施,降低PCI术中出现无复流的风险。 -
关键词:
- 急性下壁心肌梗死 /
- 无复流 /
- 经皮冠状动脉介入治疗术 /
- 危险因素
Abstract:ObjectiveTo investigate the risk factors of no-reflow in patients with acute inferior myocardial infarction during percutaneous coronary intervention(PCI). MethodsThe data of 126 acute inferior myocardial infarction patients treated with PCI were investigated, and the related risk factors of no-reflow were analyzed. ResultsOne hundred and twenty-six patients with acute inferior myocardial infarction were successfully treated with PCI, no-reflow in 16 cases were found, and the incidence rate of which was 12.70%.Logistic regression analysis showed that the diabetes(OR=1.047, 95%CI:1.019 to 1.233, P=0.036), reperfusion time(OR=5.281, 95%CI:2.782 to 10.018, P=0.002), TIMI flow grading before PCI(OR=1.735, 95%CI:1.040 to 3.062, P=0.020) and low systolic blood pressure before PCI(OR=1.844, 95%CI:1.153 to 3.638, P=0.015) were the risk factors of no-reflow. ConclusionsThe incidence of no-reflow in acute inferior myocardial infarction patients is high.The effectively preventive measures against the related risk factor of no-reflow should be implemented, which can reduce the no-reflow risk of PCI. -
表 1 一般资料比较[n; 百分率(%)]
一般资料 正常组
(n = 110)无复流组
(n= 16)t P 年龄/岁 61.94±11.35 62.88±12.18 0.25 >0.05 男/女 75/35 9/7 0.89△ >0.05 BMI/(kg/m2) 27.53±2.84 26.92±3.15 0.65 >0.05 糖尿病 40(36.36) 11(68.75) 6.08△ <0.05 高脂血症 49(44.55) 7(43.75) 0.00△ >0.05 高血压 66(67.74) 7(43.75) 1.51△ >0.05 有心肌梗死病史 21(19.09) 3(18.75) 0.10△ >0.05 饮酒 62(56.36) 10(62.50) 0.21△ >0.05 吸烟 54(27.42) 11(10.97) 2.16△ >0.05 发病至急诊PCI时间/h 5.42±0.47 7.15±1.13 4.81# <0.01 术前TIMI血流分级≤1级 64(58.18) 14(87.50) 5.09 <0.05 术前收缩压/mmHg 121.34±18.26 103.68±20.74 2.90 <0.01 术前舒张压/mmHg 64.95±15.68 67.23±17.93 0.44 >0.05 肌钙蛋白T峰值/(nmol/L) 1.46±0.35 3.72±1.31 5.44# <0.01 白细胞计数/(10-9/L) 10.03±2.84 9.55±2.84 0.51 >0.05 狭窄程度/% 78.28±7.17 80.40±8.69 0.88 >0.05 病变长度/mm 27.92±3.43 27.15±2.86 0.69 >0.05 支架管径/mm 3.06±0.44 3.18±0.42 0.83 >0.05 左室射血分数/% 44.25±8.68 47.93±8.93 1.28 >0.05 △示χ2值;#示t′值 表 2 自变量赋值
自变量 赋值方式 糖尿病 否=0,是=1 发病至急诊PCI时间 < 6 h=0,6~12 h=1,>12 h=2 术前TIMI血流分级(≤1级) 是=0,否=1 术前收缩压 ≥110 mmHg = 0,< 110 mmHg=1 肌钙蛋白T峰值 ≤2.0 nmol/L=0,>2 nmol/L=1 表 3 急性下壁心肌梗死病人急诊PCI术中出现无复流的危险因素logistic分析
因素 B Waldχ2 OR 95%CI P 常数项 -2.203 0.048 5.283 2.861~9.460 < 0.05 糖尿病 1.119 3.658 1.647 1.242~1.845 < 0.05 发病至急诊PCI时间 3.132 6.883 5.281 2.782~10.018 < 0.01 术前TIMI血流分级(≤1级) 2.083 2.682 2.735 1.040~3.062 < 0.05 术前收缩压 6.162 3.442 1.844 1.153~3.638 < 0.05 肌钙蛋白T峰值 2.105 5.353 1.064 1.019~1.233 < 0.05 -
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