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1、急性心肌梗死后合并心源性休克的相关危险因素分析摘要:[目的]从急性心肌梗死(acutemyocardialinfarction,AMI)患者中筛选出心源性休克(cardiogenicshock,CS)的相关危险因素,为临床医生和预防医学工作者提供参考依据。[方法]以1994〜2004年中山大学和昆明医学院两所附属医院的2173例ST段抬高型AMI患者为研究对象,以是否发生CS为应变量,以患者的病史、性别、年龄、家族史、生活习惯和入院时的体检指标、治疗情况等指标为自变量,建立logistic回归模型,从而筛选出与C
2、S密切相关的有价值的临床指标。[结果]年龄、性别、体重指数、心功能分级、心梗部位、外周动脉疾病、既往心梗病史、心血管病家族史,以及不接受溶栓治疗是与CS相关的9项危险因素。有心血管病家族史者发生CS的风险比无心血管病家族史者升高约43倍。未接受溶栓以及溶栓不成功者发生CS的可能性比溶栓成功者高15倍。在溶栓成功者中,41%的人在症状发作后6h内接受溶栓治疗;而在溶栓不成功者中,56%的人在症状发作超过12h才开始溶栓。[结论]AMI症状发作后早期接受溶栓治疗能大大减少CS的发生,早期溶栓治疗可作为中国老年人群CS
3、第三级预防的一个有效手段。关键词:心源性休克;急性心肌梗死;危险因素;中国人TheRiskFactorsforCardiogenicShockafterAcuteMyocardialInfarctioninChinesePatientsZHANGMini,2,LIJian3,CAIYi-mingl,2,MAHong2(l.Dept.ofCardiology,TheFirstAffiliatedHospitalofKunmingMedicalUniversity,Kunming650032,China;2.Dept
4、,ofCardiology,TheFirstAffiliatedHospitalofSunYat-senUniversity,Guangzhou510080,China;3.SchoolofPublicHealth,FudanUniverstty,Shanghai,200032,China)Abstract:[Objective]Todetecttheriskfactorsforcardiogenicshock(CS)afteracutemyocardialinfarction(AMI)amongChinesep
5、atientssoastoguidephysiciansandpublichealthprofessionalstopreventandcontrolit.[Methods]PatientsofAMIwithST-segmentelevationwererecruitedfromtwoChinesehospitalsduring1994-2004.Basiccharacteris廿csofeachcaseweredocumented.Multivariatelogisticregressionmodelingte
6、chniquewasusedtoexploretheriskfactorsofCSonsetafteradmission.[Results]Age,gender,BMbKillipclass,Mllocation,periphralarterialdisease,previousMl,familyhistoryofcoronaryarterydisease,andthrombolytictherapywerethe9importantriskfactorstoshockafterAMI.Theriskofdeve
7、lopingshockinpatientswithfailedthrombolysisorwithoutthistherapywas15timeshigherthanthosewithsuccessfulthrombolysis.Amongpatientswithfailedthrombolysis,56%hadthedelaysexceeding12hoursaftertheonsetofAMI,andamongthosewithsuccessfulthrombolysis,41%wasadministered
8、bythrombolyticagentswithin6hours・[Conclusion]TheavoidaneeofCShasbeenobservedwhenthombolytictherapyisadministeredasearlyaspossible.ThethombolytictherapyisrecommendedtothethirdpreventionofC