急性心肌梗死急诊经皮冠状动脉介入治疗患者院内死亡因素分析..doc

急性心肌梗死急诊经皮冠状动脉介入治疗患者院内死亡因素分析 任 晖，2 黄立勋1 庄贵华1 巩 洁2 李 静2 祝 鹏2 王甲文2 袁 博2 郑时康2 高天林2 （1西安交通大学医学院，陕西 西安 710061，2安康市中心医院心血管内科，陕西 安康725000） 摘要 目的：分析急性心肌梗死(AMI)患者行急诊经皮冠状动脉介入治疗（PCI）手术住院期间死亡的危险因素及死亡原因。方法：438例接受急诊PCI的AMI患者，根据住院期间存活与否，分为死亡组(21例)和存活组(417例)，比较两组患者的临床特征和冠状动脉造影及介入治疗结果，分析发生院内死亡的原因及死亡预测因素。结果：死亡组患者中年龄＞65岁、心功能Killp分级≥2级、心源性休克、广泛前壁梗死、多支闭塞（≥2支）、近段闭塞、梗死相关动脉（IRA）开通后即刻TIMI血流≤2级、IRA开通后即刻血压下降与存活组相比较差异有统计学意义(均P＜0.05)。多因素logistic回归分析表明年龄＞65岁、心功能Killp分级≥2级、心源性休克、广泛前壁梗死、IRA开通后即刻TIMI血流≤2级是急诊PCI患者围术期死亡的独立预测因素。死亡原因中,心源性休克8例（38.1%）、恶性心律失常6例（28.6%）分居第一和第二位。结论：年龄＞65岁、心功能Killp分级≥2级、心源性休克、广泛前壁梗死、IRA开通后即刻TIMI血流≤2级是急诊PCI患者围术期死亡的危险因素。心源性休克、恶性心律失常是急诊PCI手术住院期间主要死亡原因。 关键词:冠状动脉疾病；血管成形术，经腔，经皮冠状动脉；死亡 中图分类号：R541.4 文献标识码：A 文章编号：1009-7236（2014）0 Reasons of in hospital death in treatment patients of acute myocardial infarction by emergency percutaneous coronary intervention REN Hui1,,HUANG Li-xun1,ZHUANG Gui-hua1,GONG Jie2,LI Jing2,ZHU Peng2,WANG Jia-wen2,YUAN Bo2,ZHENG Shi-kang2,GAO Tian-lin2 (1.Xi an Jiaotong University Health Science Center,Xian, Shaanxi 710061,China; 2.Department of Cardiology，Ankang Central Hospital Hospital， Ankang，Shaanxi 725000 China) Abstract AIM：To analysis of emergency PCI in patients with acute myocardial infarction (AMI) during the surgery in hospital death risk factors and the cause of death, to further improve the success rate of treatment of AMI patients.METHODS：438 patients who underwent emergency PCI in AMI patients, according to survival or not,is divided into death group (21 cases) and survival group (417 cases), compared the clinical features of two groups of patients and coronary arteriography and intervention treatment results, analysis of the causes of death of nosocomial and factors of death prediction. RESULTS：Death group of patients older than 65 years old, and cardiac function with Killp class 2 or higher, cardiogenic shock, extensive anterior wall infarction, multiple branches occlusion (≥ 2) , proximal occlusion, IRA opening immediately