CAJ | 학술논문

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。
목적：대급성심기경사（AMI）환자행경피관상동맥성형술（PCI）관상동맥재통후저혈압적발생정황급기상관인소진행분석，이기탐토급진PCI술후저혈압발생적상관인소。방법회고2011년1월지2013년11월접수급진PCI술치료적AMI환자420례，근거관상동맥재통후시부출현저혈압분위저혈압조화비저혈압조，대비량조환자적림상급수술자료，운용Logistic회귀분석저혈압적발생여환자림상자료적상관성。결과420례환자중，저혈압조178례，점42.4%，비저혈압조242례，점57.6%。재본연구관찰적인소중，량조간완전폐새병변、근단병변、하벽、우심실경사、우관상동맥병변、술후TIMI＜2급、경사전심교통、CK-MB봉치、술후제1천좌심실사혈분수존재현저차이，P＜0.05。Logistic회귀분석현시：완전폐새병변、근단병변、하벽우심실경사、우관상동맥병변가증가AMI환자급진PCI술후저혈압적발생솔，경사전심교통가감소저혈압적발생솔（P＜0.05）。결론경사전심교통가감소AMI환자급진PCI술후저혈압적발생솔；이완전폐새병변、근단병변、하벽、우심실경사、우관상동맥병변、술후TIMI혈류＜2급증가AMI환자급진PCI술후저혈압발생적위험성。
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.