急性心肌梗死发病初期血氧饱和度、平均动脉压和左室射血分数与近期预后的关系

 目的 评价急性心肌梗死(AMI)患者早期脉搏血氧饱和度(pSO2)、平均动脉压(MAP)和左室射血分数(LVEF)的变化与预后的关系.方法 随机选择128例急性心肌梗死患者为研究对象,其中39例心源性休克患者未做急诊经皮冠状动脉介入(PCI)治疗(休克常规组),28例心源性休克患者选择了急诊PCI治疗(休克PCI组),61例无心衰及休克并发症患者同期接受了急诊PCI治疗(无休克PCI对照组).分别监测入院时、急诊PCI后、入院后第4天、第8天心肌梗死患者的pSO2 、MAP和LVEF的变化.统计发病后1周内的死亡病例数.结果 入院时,休克常规组和休克PCI组患者的pSO2、MAP、LVEF均低于无休克PCI对照组(P<0.01).急诊PCI治疗后,休克PCI组患者的pSO2 、MAP、LVEF有明显提高,入院后第4天、第8天休克PCI组患者的pSO2、MAP、LVEF仍低于无休克PCI对照组,但好于休克常规组(P<0.05).发病后24 h、72 h和1周内病死率分别是,休克常规组:48.7%(19/39)、56.4%(22/39)和61.5%(24/39);休克PCI组:17.9%(5/28)、28.6%(8/28)和42.9% (12/28);无休克PCI对照组:1.6%(1/61)、4.9%(3/61)和6.6% (4/61).结论 急性心肌梗死发病初期血氧饱和度、左室射血分数的下降是预后不良的最强信号,心源性休克与冠状动脉前向血流相关动脉受累程度和心肌梗死面积相关.急诊PCI能直接开放和恢复心肌血流再灌注,有效提高血氧饱和度、改善心源性休克患者的心肌顺应性和提高左室射血分数.

Prognostic value of pulse oxygen saturation, mean arterial pressure and left ventricular ejection fraction early after onset of acute myocardial infarction

Objective To evalute prognostic value of pulse oxygen saturation（ pSO2）, mean arterial pressure（MAP）and left ventricular ejection fraction（LVEF）in early acute myocardial infarction（AMI）.Methods We studied randowly 128 patients with acute myocardial infarction including 39 casres of cardiogenic shock not undergoing percutaneeus coronary intervention（PCI） as the shock regular group,and 28 cases of cardiogenic shock and 61 cases without cardiogenic shock both undergoing PCI as the shock PCI group and contorl PC1 group,respectively. The parameters of pulse oxygen saturation, mean arterial pressure and left ventricular ejection fi＇acfion were monitored before and after PCI and on the 4th and 8th days after admission. Mortality data in the first week following onset were analyzed for each group. Results The levels of pulse oxygen saturation, mean arterial pressure and left ventricular ejection fraction were lower in the shock regular group and the shock PCI group than in the control PCI group （P〈0.01）. The indexes were improved significantly in the shock PCI group after PCI. They were still lower in surving patients of the shock PCI group than in the control PCI group in the 4th and 8 th day of hespitalization, but higher than in the shock regular group （ P 〈 0.05）.The mortalities of the patients with AMI at 24h, 72h and 168h after onset were 48.7%, 56.4%, and 61.5% in the shock regular group, 1.6%, 4.9%, and 6.6% in the shock PCI group,and 17.9%, 28.6% ,and 42.9% in the control PCI group, with statistically significant differences between the groups （P〈0.05）. Conclusions The decline of levels of pulse oxygen saturation, mean arterial pressure, and left ventricular ejection fraction early after onset of acute myocardial infarction is a worst prognostic signal. Cardiogenic shock is related to size and severity of myocardial infarction. So early revascularization can improve blood oxygen saturation and compliance of cardiac muscles and increase left ventricular ejection fraction ef