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.
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.