急性心肌梗死合并心原性休克47例治疗和死亡原因分析

目的 评价急性心肌梗死合并心原性休克47例患者的临床疗效,寻求降低病死率、改善预后的措施.方法 回顾性分析2002年1月至2007年5月共47例心肌梗死合并心原性休克患者,运用心血管活性药物、主动脉内球囊反搏(IABP)、介入手术或冠状动脉旁路移植术的治疗效果.结果 IABP治疗47例(100%),再血管化治疗41例(87.3%),死亡17例(36.2%).经药物和IABP治疗,在接受再血管化前死亡的患者占死亡数的35.3%(6/17),再血管化后死亡的患者占死亡数的64.7%(11/17).死于心功能衰竭者9例,死于肾功能衰竭和呼吸功能衰竭者8例.11例出现急性肾功能衰竭的患者全部死亡.急性肾功能衰竭(r=0.734,P=0.000)、急性呼吸功能衰竭(r=0.606,P=0.000)和糖尿病(r=0.372,P=0.012)与死亡有相关关系.结论 尽管急性心肌梗死合并心原性休克的治疗有了很大的发展,但病死率仍然较高,主要死因是急性心力衰竭、急性肾功能衰竭和急性呼吸功能衰竭.要进一步降低急性心肌梗死合并心原性休克患者住院病死率,可能需要更好的循环辅助装置及加强重要器官的保护.

Management and outcome of 47 patients with acute myocardial infarction complicating cardiogenic shock

Objective To evaluate the clinical outcomes of patients with acute myocardial infarction(AMI)complicating cardiogenic shock underwent various treatments.Methods From January,2002 to May,2007,47 AMI patients with cardiogenic shock were treated in our department by optimal medication (dopamine,epinephrine,norepinephrine,etc.),intrar-aortic balloon pump(IABP),mechanical ventilation when indicated,percutaneous coronary intervention(PCI)or coronary artery bypass graft (CABG).Outcome and factors related to mortality for these patients were analyzed in this retrospective study.Results Besides optimal medication and IABP in all patients,31 patients underwent PCI(66.0%),6 patients received emergency CABG(12.8%).The overall in-hospital mortality rate was 36.2%(17/47),6 patients(14.9%)died before coronary revascularization and 11 patients(21.3%)died after revascularization.Nine patients died of pump failure and 8 patients died of renal and(or)respiratory failure.Regression analysis showed that acute renal failure(r=0.734,P=0.000),acute respiratory failure (r=0.606,P=0.000)and diabetes(r=0.372,P=0.012)were positively related to in-hospital mortality.Conclusion Despite improvements in treatment options for AMI patients complicating cardiogenic shock,in-hospital mortality remained high,especially for patients complicating further with acute renal failure and acute respiratory failure.