急性心肌梗死后合并心源性休克的相关危险因素分析

目的]从急性心肌梗死(acute myocardial infarction,AMI)患者中筛选出心源性休克(cardiogenic shock,CS)的相关危险因素,为临床医生和预防医学工作者提供参考依据。方法]以1994～2004年中山大学和昆明医学院两所附属医院的2173例ST段抬高型AMI患者为研究对象,以是否发生CS为应变量,以患者的病史、性别、年龄、家族史、生活习惯和入院时的体检指标、治疗情况等指标为自变量,建立logistic回归模型,从而筛选出与CS密切相关的有价值的临床指标。结果]年龄、性别、体重指数、心功能分级、心梗部位、外周动脉疾病、既往心梗病史、心血管病家族史,以及不接受溶栓治疗是与CS相关的9项危险因素。有心血管病家族史者发生CS的风险比无心血管病家族史者升高约43倍。未接受溶栓以及溶栓不成功者发生CS的可能性比溶栓成功者高15倍。在溶栓成功者中,41%的人在症状发作后6h内接受溶栓治疗;而在溶栓不成功者中,56%的人在症状发作超过12h才开始溶栓。结论]AMI症状发作后早期接受溶栓治疗能大大减少CS的发生,早期溶栓治疗可作为中国老年人群CS第三级预防的一个有效手段。

The Risk Factors for Cardiogenic Shock after Acute Myocardial Infarction in Chinese Patients

Objective]To detect the risk factors for cardiogenic shock (CS)after acute myocardial infarction (AMI) among Chinese patients so as to guide physicians and public health professionals to prevent and control it.Methods] Patients of AMI with ST-segment elevation were recruited from two Chinese hospitals during 1994-2004.Basic characteristics of each case were documented.Multivariate logistic regression modeling technique was used to explore the risk factors of CS onset after admission.Results] Age,gender,BMI,Kilhp class,MI location,periphral arterial disease,previous MI,family history of coronary artery disease,and thrombolytic therapy were the 9 important risk factors to shock after AMI.The risk of developing shock in patients with failed thrombolysis or without this therapy was 15 times higher than those with successful thrombolysis. Among patients with failed thrombolysis,56% had the delays exceeding 12 hours after the onset of AMI,and among those with successful thrombolysis,41% was administered by thrombolytic agents within 6 hours.Conclusion] The avoidance of CS has been observed when thombolytic therapy is administered as early as possible.The thombolytic therapy is recommended to the third prevention of CS in the elderly Chinese population.