| 急性心肌梗死急诊经皮冠状动脉介入治疗患者院内死亡因素分析 |
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| 引用本文： | 任晖,;黄立勋,;庄贵华,;巩洁,;李静,;祝鹏,;王甲文. 急性心肌梗死急诊经皮冠状动脉介入治疗患者院内死亡因素分析[J]. 心脏杂志, 2014, 26(6): 662-665 |
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| 作者姓名： | 任晖, 黄立勋, 庄贵华, 巩洁, 李静, 祝鹏, 王甲文 |
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| 作者单位： | (1.西安交通大学医学部公共卫生学院，陕西 西安 710061； |
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| 摘 要： | 目的:分析急性心肌梗死(AMI)患者行急诊经皮冠状动脉介入治疗(PCI)手术住院期间死亡的危险因素及死亡原因。方法:438例接受急诊PCI的AMI患者,根据住院期间存活与否,分为死亡组(21例)和存活组(417例),比较两组患者的临床特征和冠状动脉造影及介入治疗结果,分析发生院内死亡的原因及死亡预测因素。结果:死亡组患者中年龄65岁、心功能Killp分级≥Ⅱ级、心源性休克、广泛前壁梗死、多支闭塞(≥2支)、近段闭塞、梗死相关动脉(IRA)开通后即刻TIMI血流≤Ⅱ级、IRA开通后即刻血压下降与存活组相比较差异有统计学意义(均P0.05)。多因素logistic回归分析表明年龄65岁、心功能Killp分级≥Ⅱ级、心源性休克、广泛前壁梗死、IRA开通后即刻TIMI血流≤Ⅱ级是急诊PCI患者围术期死亡的独立预测因素。死亡原因中,心源性休克8例(38.1%)、恶性心律失常6例(28.6%)分居第1和第2位。结论:年龄65岁、心功能Killp分级≥Ⅱ级、心源性休克、广泛前壁梗死、IRA开通后即刻TIMI血流≤Ⅱ级是急诊PCI患者围术期死亡的危险因素。心源性休克、恶性心律失常是急诊PCI手术住院期间主要死亡原因。
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| 关 键 词： | 冠状动脉疾病 血管成形术，经腔，经皮冠状动脉 死亡 |
| 收稿时间： | 2014-03-01 |
Analysis of in-hospital death in acute myocardial infarction patients treated with emergency percutaneous coronary intervention |
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| Affiliation: | REN Hui, HUANG Li-xun, ZHUANG Gui-hua, GONG Jie, Y Jing, ZHU Peng, WANG Jia-wen ( 1. School of Public Health, College of Medicine, Xi＇ an Jiaotong University, Xi＇ an 710061, Shaanxi, China; 2. Department of Cardiology, Ankang Central Hospital, Ankang 725000, Shaanxi, China) |
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| Abstract: | AIM：To analyze the risk and death-causing factors of in-hospital death in acute myocardial infarction patients treated with emergency percutaneous coronary intervention （PCI）. METHODS： Four hundred and thirty-eight AMI patients treated with emergency PCI were divided into death group （21 cases） and survival group （417 cases）. Clinical features, coronary arteriography and intervention treatment results of the two groups were compared and the risk and death-causing factors of in-hospital death were analyzed. RESULTS： In death group, the rates of patients 〉65 years old, cardiac function with Killip class II or higher, cardiogenic shock, extensive anterior wall infarction, multiple branch occlusion （≥2）, proximal occlusion, IRA opening immediately TIMI flow grade II or less and decrease of blood pressure were significantly different from those in the survival group （P〈0.05）. Multivariate logistic regression analysis showed that age 〉65 years old, cardiac function Killip class II or higher, cardiogenic shock, extensive anterior wall infarction, and IRA opening immediately TIMI flow grade II or less were independent predictors of death in emergency PCI patients. Cardiogenic shock （eight cases, 38.1%） and malignant arrhythmia （six cases, 28.6%） were the first and second leading causes of death. CONCLUSION： In patients 〉65 years, cardiac functional grading of Killip II or higher, cardiogenic shock, extensive anterior wall infarction, and IRA opening TIMI flow grade II or less are the perioperative risk factors for death in patients treated with emergency PCI. Cardiogenic shock and malignant arrhythmia are the main causes of death in emergency PCI surgical patients during hospitalization. |
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| Keywords: | coronary artery disease angioplasty, transluminal, percutaneous coronary prognosis death |
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