急性心肌梗死并发心源性休克的临床特征与救治

目的　评价急性心肌梗死 (AMI)并心源性休克的临床特征 ,总结救治经验。方法　 10 8例 AMI患者 ,分为休克组 (11例 )与非休克组 (97例 ) ,对比分析两组患者的临床特征、处理与近期预后的异同。结果　两组患者年龄、性别、糖尿病、冠心病、高脂血症、陈旧性心肌梗死病史及梗死部位无显著性差异 (P均 >0 .0 5 )。与非休克组比较 ,休克组肌酸磷酸激酶和心肌肌钙蛋白 I升高〔(31979.7± 2 2 2 71.1) nm ol· s- 1· L- 1比 (17795 .2± 14 979.7) nmol· s- 1· L- 1和 (90 .7± 6 1.1) μg/ L 比 (39.9± 5 2 .1) μg/ L,P均 <0 .0 5〕,左室射血分数降低 (0 .4 6± 0 .12比 0 .5 5± 0 .12 ,P<0 .0 5 ) ,急性肺水肿、心律失常和肺炎合并症增多 (6 4 %比 14 % ,P<0 .0 0 1;5 5 %比 2 1% ,P<0 .0 5 ;4 6 %比 12 % ,P<0 .0 1) ,采用溶栓治疗、冠状动脉造影、主动脉内气囊反搏者多 (46 %比 18% ,73%比 2 6 %和 36 %比 4 % ,P均 <0 .0 5 )。两组住院期病死率无显著性差异 (0比 4 % ,P>0 .0 5 )。结论　 AMI并休克者心肌梗死面积大 ,急性肺水肿、心律失常和肺炎合并症多 ,需主动脉内气囊反搏者多。正确判断、严密监测、及时有效处理 ,可明显改善患者的早期预后。

Clinical features and treatment of cardiogenic shock complicated with acute myocardial infarction

OBJECTIVE: To identify the clinical features and the outcome of patients with cardiogenic shock complicating acute myocardial infarction (AMI). METHODS: One hundred and eight consecutive patients with AMI were included in this retrospective analysis. The characteristics, management, and outcome of patients with AMI were compared between patients with cardiogenic shock (group A, n=11) and without cardiogenic shock (group B, n=9). RESULTS: There was no difference in the age and other characteristics including proportion of women, diabetics, prior myocardial infarction and the position of myocardial infarction. The levels of peak creatine kinase and troponin I were (31979.7+/-22271.1)nmol x s(-1) x L(-1) and (90.7+/-61.1) microg/L respectively in group A, they were higher than those in group B (17795.2+/-14979.7)nmol.s-1.L-1 and (39.9+/-52.1) microg/L, respectively (both P<0.05). The left ventricular ejection fraction was significantly lower in group A than that in group B (0.46+/-0.12 vs. 0.55+/-0.12, P<0.05). Patients in group A had a higher proportion of pump failure, arrhythmia and pneumonia (64% vs. 14%, P<0.001; 55% vs. 21 %, P<0.05; and 46% vs. 12%, P<0.01, respectively) than those in group B. In addition, in group A patients often underwent thrombolysis of urokinase, coronary angiography and intra-aortic balloon counterpulsation (46% vs. 18%, 73% vs. 26% and 36% vs. 4%, all P<0.05, respectively). There was no difference in in-hospital mortality between group A and group B (0 vs. 4%, P>0.05). CONCLUSION: Shock patients more likely have pump failure, arrhythmia, and pneumonia and more often underwent intra-aortic balloon counterpulsation. If cardiogenic shock complicating AMI is managed with rapid evaluation and prompt initiation of supportive measures and definitive therapy, outcomes can be improved.