急性心肌梗死后心源性休克患者早期发生急性肾功能衰竭与预后的关系

目的　了解急性心肌梗死后心源性休克患者中早期发生急性肾功能衰竭与预后的关系。方法回顾性分析解放军总医院 1993— 2 0 0 3年因急性心肌梗死或冠心病心绞痛住院、并出现心源性休克患者的临床资料。以 2 4 h内是否出现急性肾功能衰竭为标准 ,比较其住院期间病死率 ;并采用多元 logistic回归分析 ,评估早期发生急性肾功能衰竭对患者预后的影响。结果　 172例患者中 ,5 1例 ( 30 % )于 2 4 h内出现急性肾功能衰竭。早期是否发生急性肾功能衰竭患者的住院病死率分别为 90 % ( 4 6 / 5 1例 )和 5 6 % ( 6 8/ 12 1例 )。逐步回归分析表明 ,早期发生急性肾功能衰竭是影响急性心肌梗死后心源性休克患者预后的独立因素 ,相对危险度 ( OR) =6 .7,95 %可信区间为 2 .5～ 18.0 ,P<0 .0 0 1。结论　急性心肌梗死后心源性休克患者 ,早期急性肾功能衰竭的发生与患者住院病死率显著相关 ,可作为判断患者预后不良的指标

Prognostic significance of early acute renal failure in patients with cardiogenic shock after acute myocardial infarction

Objective To investigate the relationship between early developed acute renal failure and the prognosis of patients with cardiogenic shock after myocardial infarction. Methods All patients who were consecutively to the General Hospital of PLA from 1993 to 2003 admitted with the diagnosis of acute myocardial infarction or unstable angina in the state of cardiogenic shock were enrolled. Inhospital mortality was compared between patients with and without early (<24 hours after onset of shock) developed acute renal failure. Multivariate logistic regression analysis was performed to assess the impact of acute renal failure on the prognosis of these patients. Results Fiftyone (30%) of 172 patients developed acute renal failure within 24 hours after the onset of shock. Inhospital mortality in patients with and without acute renal failure were 90%(46/51 cases) and 56%(68/121 cases), respectively. Multivariate logistic regression analysis identified acute renal failure as an independent predictor of mortality (odds ratio=6 5; 95% confidence interval: 2 518 0; P <0 001). Conclusion Acute renal failure is common in patients with cardiogenic shock and strongly associated with inhospital mortality.