血浆晶体渗透压对急性心肌梗死患者预后影响的研究

目的评估血浆晶体渗透压对急性心肌梗死（AMI）患者临床及预后的影响。方法将102例AMI患者按入院1 h内的血浆晶体渗透压水平分3组,正常血浆晶体渗透压组为N组72例,低血浆晶体渗透压组为L组21例,高血浆晶体渗透压组为H组9例,按照急性心肌梗死诊断和治疗指南处理,观察3组患者发生心力衰竭、心源性休克、心室颤动、Ⅲ度AVB、住院病死率和30d病死率的差异。结果年龄较大,有糖尿病、心肌梗死、脑卒中和心力衰竭病史者更容易出现血浆晶体渗透压异常（P〈0.05）;血浆晶体渗透压异常组更容易并发心力衰竭、心源性休克、心室颤动和Ⅲ°AVB等严重并发症（P〈0.05）;静脉溶栓冠脉再通率也显著降低（P〈0.05）;住院病死率和30d病死率亦明显增加（P〈0.05）。结论 AMI患者早期血浆晶体渗透压异常,其住院病死率和30d病死率明显增加,提示血浆晶体渗透压异常可能是影响AMI患者预后的独立危险因素。

The clinical trial of the impact of plasma crystalloid osmotic pressure on the prognosis of acute myocardial infarction

Objective To evaluate the clinical features and outcomes in patients Suffering with acute myocardial infarction（AMI） combined with plasma crystalloid osmotic pressure.Methods 102 patients suffering with AMI were divided into three groups according to the different level of plasma crystalloid osmotic pressure within one hour after hospitalization.Group N consisted of 72 patients with normal osmotic pressure.Group L consisted of 21patients with low osmotic pressure.Group H consisted of 9 patients with high osmotic pressure.All patients in three groups were treated according with Guidelines of the diagnosis and therapy for AMI.The different occurrence were observed,including heart failure,cardiac shock,ventricular fibrillation,Ⅲ°AVB,in-hospital mortality and 30-day mortality.Results Patients with abnormal crystalloid osmotic pressure were older and more likely to have history of Diabetes Mellius,myocardial infarction,stroke,and heart failure（P0.05）.Patients in Group L and Group H were more likely to suffered with complications of heart failure,cardiac shock,ventricular fibrillation,and Ⅲ°AVB（P0.05）,the coronary reperfusion rate of thrombolysis was lower obviously（P0.05）,in-hospital mortality and 30-day mortality were increased obviously（P0.05）.Conclusion abnormal crystalloid osmotic pressure was associated with a markedly increased risk of in-hospital mortality and 30-day mortality,may be an independent risk factor of prognosis of AMI.