学术论文

      IABP辅助治疗重症急性冠脉综合征患者近期死亡的危险因素分析

      Risk factors of short-term mortality in patients with severe acute coronary syndrome treated with adjuvant intraaortic balloon pumping

      摘要:
      目的 讨论主动脉球囊反搏术(IABP)辅助治疗重症急性冠脉综合征(ACS)患者30 d死亡的影响因素.方法 入选2014年10月~2017年5月于青岛市市立医院行IABP的重症ACS患者239例,其中女性70例(19.3%),根据30 d生存情况,分为30 d存活组198例,30 d死亡组41例,比较两组患者的一般资料,采用单因素及多因素二元Logistic回归分析该人群30 d死亡的危险因素.结果 与30天存活组相比,30 d死亡组患者中女性、ST段抬高型心肌梗死、心源性休克、单纯药物保守治疗患者所占比例更高,心率更快(P均<0.05),行冠状动脉旁路移植(CABG)治疗、预置入IABP患者所占比例较低(P均<0.05),多因素二元Logistic回归分析发现:经皮冠状动脉介入治疗(PCI)(OR= 0.28, 95%CI:0.08~0.94,P=0.039)是IABP辅助重症ACS患者30 d死亡的保护因素,女性(OR=2.45,95%CI:1.01~5.92,P=0.047)、心源性休克(OR=7.86,95%CI:2.83~21.81,P<0.001)是IABP辅助重症ACS患者30 d死亡的独立危险因素.结论 PCI是IABP辅助重症ACS患者的30 d死亡的保护因素.女性、心源性休克是IABP辅助重症ACS患者30 d死亡的独立危险因素.支持在治疗过程中,尤其是对女性患者,应积极纠正心源性休克并尽可能选择PCI治疗.
      Abstract:
      Objective To discuss the influencing factors of adjuvant intraaortic balloon pumping (IABP) on 30-d death in patients with severe acute coronary syndrome (ACS). Methods The patients with severe ACS (n=239), among them female were 70 (19.3%), were chosen from Qingdao Municipal Hospital from Oct. 2014 to May 2017. All patients were divided, according to 30 d survival state, into 30 d survival group (n=198) and 30 d death group (n=41). The general data was compared between 2 groups, and risk factors of 30 d death were analyzed by using single-factor and multi-factor binary Logistic regression analysis. Results Compared with 30 d survival group, the percentages of female, cases of ST-segment elevation myocardial infarction (STEMI), cardiogenic shock and treated with drug conservative therapy were higher, and heart rate was faster in 30 d death group (all P<0.05). The percentages of patients treated with coronary artery bypass grafting (CABG) and pretreatment of IABP were lower in 30 d death group (all P<0.05). The results of multi-factor binary Logistic regression analysis showed that percutaneous coronary intervention (PCI) is a protective factor of 30 d death in ACS patients treated with adjuvant IABP (OR=0.28, 95%CI: 0.08~0.94, P=0.039). Female (OR=2.45, 95%CI: 1.01~5.92, P=0.047) and cardiogenic shock (OR=7.86, 95%CI: 2.83~21.81, P<0.001) were independent risk factors of 30 d death in ACS patients treated with adjuvant IABP. Conclusion PCI is a protective factor, and female and cardiogenic shock are independent risk factors of 30 d death in ACS patients treated with adjuvant IABP. During the therapeutic course, cardiogenic shock should be corrected actively and PCI is chosen as far as possible especially for female patients.
      作者: 吴国良 [1] 延荣强 [2] 刘刚 [1] 杨璐 [1] 王海洋 [2] 耿强 [2] 任永强 [2] 范树信 [2] 张俊义 [2] 王正忠 [2] 于忠祥 [2] 池一凡 [3]
      Author: Wu Guoliang [1] Yan Rongqiang [2] Liu Gang [1] Yang Lu [1] Wang Haiyang [2] Geng Qiang [2] Ren Yongqiang [2] Fan Shuxin [2] Zhang Junyi [2] Wang Zhengzhong [2] Yu Zhongxiang [2] Chi Yifan [3]
      作者单位: 266000 青岛,青岛大学;266000 青岛,青岛大学附属青岛市市立医院心内科 青岛大学附属青岛市市立医院心内科, 青岛,266000 青岛大学附属青岛市市立医院心外科, 青岛,266000
      年,卷(期): 2018, 10(4)
      分类号: R541.4
      在线出版日期: 2018年6月15日