老年急性心肌梗死患者经皮冠状动脉介入术后急性肾损伤现状及影响因素

目的 探讨老年急性心肌梗死(AMI)患者经皮冠状动脉介入术(PCI)后急性肾损伤(AKI)现状及其影响因素。方法 回顾性分析长治医学院附属和济医院2020年6月至2022年6月收治的189例老年AMI患者的临床资料,患者均行PCI治疗,根据术后是否出现AKI,将其分为AKI组(n=65)和非AKI组(n=124),记录患者一般资料、实验室检查及预后情况。采用SPSS 19.0统计软件进行数据分析。根据数据类型,分别采用t检验或χ²检验进行组间比较。采用多因素logistic回归分析老年AMI患者PCI术后并发AKI的影响因素。结果 189例老年AMI患者中,65例患者并发AKI(34.39%)。AKI组患者住院时间长于非AKI组；心力衰竭、感染、出血、自动出院及死亡例数均多于非AKI组,差异均有统计学意义(P<0.05)。多因素logistic回归分析提示,糖尿病(OR=3.766,95%CI 2.031~6.982)、心功能Killip分级(OR=3.043,95%CI 1.966~4.712)、白细胞计数(OR=1.877,95%CI 1.058~3.364)及N端脑钠肽前体(OR=2.570,95%CI 1.386~4.765)是影响老年AMI患者PCI术后AKI发生的危险因素；肾小球滤过率(OR=0.470,95%CI 0.327~0.676)是其保护因素。结论 老年AMI患者PCI术后AKI发生率较高,AKI将增加预后不良发生率,建议临床注重合并糖尿病及心功能不佳者的治疗及护理,同时可借助基线肾小球滤过率、白细胞计数及N端脑钠肽前体水平判断患者并发AKI的风险。

Status quo and influencing factors of acute kidney injury in elderly patients with acute myocardial infarction after percutaneous coronary intervention

Objective To investigate the status quo and influencing factors of acute kidney injury (AKI) in elderly patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). Methods The clinical data of 189 elderly AMI patients admitted to our hospital from June 2020 to June 2022 were retrospectively analyzed. All patients underwent PCI and were divided into AKI group (n=65) and non-AKI group (n=124) according to whether AKI occurred after surgery. General data, results of laboratory examination, and prognosis status were recorded among the patients. SPSS statistics 19.0 was used for data analysis. According to the data types, student′s t test or Chi-square test was performed for comparison between groups. Multivariate logistic regression analysis was adopted to analyze the related factors affecting AKI after PCI in the elderly AMI patients. Results Among the 189 elderly AMI patients, 65 patients were complicated with AKI (34.39%). The AMI group had significantly longer hospital stay and larger proportions of heart failure, infection, bleeding, automatic discharge and death than the non-AKI group (P<0.05). Multivariate logistic regression analysis revealed that diabetes mellitus (OR=3.766, 95%CI 2.031-6.982), cardiac function Killip grade (OR=3.043, 95%CI 1.966-4.712), white blood cell (WBC) count (OR=1.877, 95%CI 1.058-3.364) and N-terminal pro-brain natriuretic peptide (NT-proBNP) level (OR=2.590, 95%CI 1.386-4.765) were risk factors for occurrence of AKI in elderly AMI patients after PCI, and estimated glomerular filtration rate (eGFR, OR=0.470, 95%CI 0.327-0.676) was a protective factor. Conclusion The incidence of AKI is quite high in elderly AMI patients after PCI, and AKI will increase poor prognosis. For the patients complicated with diabetes mellitus and poor cardiac function, special attention should be paid to their treatment and nursing in clinical practice. In addition, baseline eGFR, WBC count and NT-proBNP level can be used to assess the risk of AKI in the patients.