急性心肌梗死患者急诊经皮冠状动脉成形术后低血压的相关因素分析

目的对急性心肌梗死(AMI)患者行经皮冠状动脉成形术(PCI)冠状动脉再通后低血压的发生情况及其相关因素进行分析,以期探讨急诊PCI术后低血压发生的相关因素。方法回顾2011年1月至2013年11月接受急诊PCI术治疗的AMI患者420例,根据冠状动脉再通后是否出现低血压分为低血压组和非低血压组,对比两组患者的临床及手术资料,运用Logistic回归分析低血压的发生与患者临床资料的相关性。结果 420例患者中,低血压组178例,占42.4%,非低血压组242例,占57.6%。在本研究观察的因素中,两组间完全闭塞病变、近段病变、下壁、右心室梗死、右冠状动脉病变、术后TIMI<2级、梗死前心绞痛、CK-MB峰值、术后第1天左心室射血分数存在显著差异,P<0.05。Logistic回归分析显示:完全闭塞病变、近段病变、下壁右心室梗死、右冠状动脉病变可增加AMI患者急诊PCI术后低血压的发生率,梗死前心绞痛可减少低血压的发生率(P<0.05)。结论梗死前心绞痛可减少AMI患者急诊PCI术后低血压的发生率;而完全闭塞病变、近段病变、下壁、右心室梗死、右冠状动脉病变、术后TIMI血流<2级增加AMI患者急诊PCI术后低血压发生的危险性。

Analysis on the relative factors of hypotension after recanalization of IRA for AMI patients

Objective To investigate the risk and relative factors for occurrence of hypotension after recanalization of IRA （infarct-related artery） during PCI （percutaneous coronary intervention） for acute myocardial infarction（AMI）. Methods Clinical and PCI data of 420 patients in whom the infarct-related artery（IRA） was successfully recanalized by primary PCI for AMI in the first affiliated hospital of Soochow University from January 2011 to November 2013 were retrospectively analyzed. These patients were divided into the hypotension group and non-hypotension group. Multivariate Logistic regression model was used to investigate the relation between hypotension and these data. Results 42.4%of these 420 patients （178 patients） had got hypotension after the recanalization of IRA. After comparing all the clinical and PCI data of the two groups, we found that there were no significant differences in gender, age, percentage of hypertension、diabetes、hyperlipidemia, smoken, onset time, peak value of CK-MB, multivessel lesion. Angina pectoris before infarction, inferior wall or right ventricular infarction, right coronary artery lesion, total occlusion lesion,proxima vessel lesion and TIMI〈2 after PCI in hypotension group were higher than those of non-hypotension group （P〈0.05）. Conclusion Inferior wall or right ventricular infarction, right coronary artery lesion, total occlusion lesion proxima vessel lesion and TIMI〈2 after PCI can increase the possibility of hypotension after PCI, and angina pectoris before infarction can reduce the incidence of hypotension after PCI.