主动脉内球囊反搏术对行经皮...术后院内死亡的危险因素分析_周陈琛.pdf

现代生物医学进展Progress in Modern Biomedicine Vol.23NO.1JAN.2023doi:10.13241/ki.pmb.2023.01.011主动脉内球囊反搏术对行经皮冠状动脉介入术 AMI 合并 CS 患者的影响及术后院内死亡的危险因素分析*周陈琛钟文婷刘巍王雪范羽飞（南京医科大学附属南京医院（南京市第一医院）心血管内科 CCU 江苏 南京 210006）摘要 目的：分析主动脉内球囊反搏术（IABP）对行经皮冠状动脉介入术（PCI）急性心肌梗死（AMI）合并心源性休克（CS）患者的影响及术后院内死亡的危险因素。方法：选取 2020 年 6 月-2022 年 5 月我院收治的 105 例 AMI 合并 CS 患者，将直接行 PCI 治疗患者设为对照组（n=59 例），行 IABP 辅助支持下 PCI 治疗患者设为研究组（n=46 例）。比较两组术后心脏指标左室射血分数（LVEF）、左室舒张末期内径（LVEDD）和左室收缩末期内径（LVESD）、心肌酶谱指标心肌肌钙蛋白 T 与肌钙蛋白 I、肌酸激酶同工酶（CK-MB）、术后主要心血管不良事件。根据患者出院时是否存活分为存活组（n=74）与死亡组（n=31），比较两组临床资料，采用多因素 Logistic 回归模型分析患者院内死亡的危险因素。结果：术后两组 LVEF 较术前提高，LVEDD、LVESD 降低，且研究组LVEF 高于对照组，LVEDD、LVESD 低于对照组（P0.05）。术后两组心肌酶谱指标较术前显著下降，且研究组肌钙蛋白 I、肌钙蛋白T、CK-MB水平低于对照组（P0.05）。术后对照组发生5例再发心肌梗死、7例急性血栓形成，研究组分别为 2 例、3 例（P0.05）；对照组死亡 23 例，研究组死亡 8 例，研究组死亡人数低于对照组（P0.05）。死亡组年龄、Killip 分级级、高血脂、LVEF40%、TIMI 血流分级级占比、白细胞计数、血肌酐水平高于存活组，收缩压、舒张压、血红蛋白、肌钙蛋白 I、肌钙蛋白 T、CK-MB、LVEF、IABP 辅助低于存活组（P0.05）。多因素 Logistic 回归分析显示，年龄65 岁、Killip 分级级、LVEF40%、TIMI 血流分级级为患者院内死亡的危险因素（P0.05）。结论：IABP 辅助支持下的 PCI 能有效改善 AMI 合并 CS 患者心功能，年龄65 岁、Killip 分级级、LVEF40%、TIMI 血流分级级为等为其院内死亡危险因素。关键词：急性心肌梗死；心源性休克；主动脉内球囊反搏术；经皮冠状动脉介入术；死亡；危险因素中图分类号：R542.22；R541.64文献标识码：A文章编号：1673-6273（2023）01-58-06Effect of Intra Aortic Balloon Counterpulsation on Patients with AMIComplicated with CS Undergoing Percutaneous Coronary Intervention andAnalysis of Risk Factors of Postoperative in-Hospital Death*ZHOU Chen-chen,ZHONG Wen-ting,LIU Wei,WANG Xue,FAN Yu-fei(Coronary Heart Disease Intensive Care Unit,Nanjing First Hospital(Nanjing Hospital Affiliated to Nanjing Medical University),Nanjing,Jiangsu,210006,China)ABSTRACT Objective:To analyze the effect of intra aortic balloon counterpulsation(IABP)on patients with acute myocardial in-farction(AMI)complicated with ardiogenic shock(CS)undergoing percutaneous coronary intervention(PCI)and the risk factors of post-operative in-hospital death.Methods:105 patients with AMI complicated with CS who were treated in our hospital from June 2020 toMay 2022 were selected.The patients treated with PCI directly were set as the control group(n=59 cases),and the patients treated withPCI assisted by IABP were set as the study group(n=46 cases).The postoperative cardiac indexesleft ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD)and left ventricular end systolic diameter(LVESD),myocardial zymogram in-dexes cardiac troponin T and troponin I,creatine kinase isoenzyme(CK-MB)and postoperative major cardiovascular adverse eventswere compared between the two groups.The patients were divided into survival group(n=74)and death group(n=31)according towhether they survived at discharge.The clinical data of the two groups were compared,and the risk factors of in-hospital death were ana-lyzed by multivariate logistic regression model.Results:The LVEF of the two groups after operation was increased,LVEDD and LVESDwere decreased,and LVEF of the study group was higher than that of the control group,and LVEDD and LVESD were lower than thoseof the control group(P0.05).The myocardial zymogram indexes of the two groups after operation were significantly decreased com-pared with those before operation,and the levels of troponin I,troponin T and CK-MB of the study group were lower than those of thecontrol group(P0.05).There were 5 cases of recurrent myocardial infarction and 7 cases of acute thrombosis of the control group afteroperation,2 cases and 3 cases of the study group respectively(P0.05).There were 23 deaths of the control group,and 8 deaths of thestudy group.The number of deaths of the study group was lower than that of the control group(P0.05).The age,Killip grade grade*基金项目：江苏省科技发展计划项目（BL1812071）作者简介：周陈琛（1986-），女，硕士研究生，从事心血管内科重症方向的研究，E-mail:（收稿日期：2022-05-30 接受日期：2022-06-24）58现代生物医学进展Progress in Modern Biomedicine Vol.23NO.1JAN.2023III,hyperlipidemia,LVEF 40%,proportion of TIMI blood flow grade grade II,leukocyte count and serum creatinine level of thedeath group were higher than those of the survival group,and systolic blood pressure,diastolic blood pressure,hemoglobin,troponin I,troponin T,CK-MB,LVEF and IABP assisted were lower than those in the survival group(P0.05).Multivariate logistic regressionanalysis showed that age 65 years,Killip grade grade III,LVEF 40%and TIMI blood flow grade grade II were the risk factorsfor in-hospital death of patients(P0.05).Conclusion:IABP assisted supported PCI can effectively improve cardiac function in patientswith AMI complicated with CS.Age 65 years,Killip grade grade III,LVEF 55%）、左室舒张末期内径（LVEDD）（正常值范围：37-55mm）和左室收缩末期内径（LVESD）（正常值范围：23-55 mm）等指标。手术前后分别采集患者静脉血 5 mL，采用干式荧光免疫分析仪（瑞士罗氏公司，型号：E48）检测心肌肌钙蛋白 T（正常值范围14 ng/L）、干式荧光免疫分析仪（诺唯赞公司，Qds2000型号）检测心肌肌钙蛋白 I（正常值范围 0 ng/L-0.5 ng/L），干式荧光免疫分析仪（万孚公司，Wondfo FS-30 型号）检测肌酸激酶同工酶（CK-MB）水平（正常值范围 2-16 u/L）。比较两组术后1 个月内发生的主要心血管事件（包括：再发心肌梗死、急性血栓形成、死亡等）。1.2.3 预后分组根据患者出院时是否存活分为存活组与死亡组，其中死因包括泵衰竭、恶性心律失常、心脏破裂等机械并发症，呼吸衰竭及非心脏原因导致的死亡。1.2.4 临床资料收集收集患者性别、年龄、血压（收缩压、舒张压）、心率、心功能 Killip 分级、吸烟史、饮酒史、合并症（高血压、糖尿病、高血脂）等资料；术后 1 周检测白细胞计数、血红蛋白含量、血肌酐、肌钙蛋白 I、肌钙蛋白 T、