CAJ | 학술논문

目的：探讨影响基层医院急性心肌梗死(acute myocardial infarction，AMI)患者静脉溶栓效果的相关因素，通过 Logistic 回归分析，探究相关的危险性因素，为临床治疗策略的制定提供依据。方法：回顾分析2012年1月-2013年12月本院心血管内科住院使用尿激酶溶栓的 AMI 患者86例，根据患者溶栓治疗后血管是否开通分为开通组47例和未开通组39例，比较两组的一般临床资料。以血管是否开通为因变量，对可能的相关影响因素包括 BMI、溶栓时间、糖尿病、不稳定型心绞痛、吸烟以及前壁相关性心肌梗死进行 Logistic 回归分析，确定相应的危险因素。结果：86例 AMI 溶栓患者中，47例血管成功开通。开通组和未开通组比较，前者的 BMI 较大、溶栓时间较短、糖尿病患病率较低、不稳定型心绞痛发生率较低、吸烟比例较高以及前壁相关性心肌梗死的比例较高。 Logistic 回归分析的结果发现溶栓时间>5h、糖尿病、不稳定型心绞痛、非前壁相关性心肌梗死等4个因素均为血管开通失败的危险因素。结论：基层医院接诊的 AMI 患者若合并糖尿病、既往有不稳定型心绞痛、溶栓时间>5 h 或心肌梗死部位为非前壁相关性心梗时，建议尽早转运至上级医院介入中心处理。
목적：탐토영향기층의원급성심기경사(acute myocardial infarction，AMI)환자정맥용전효과적상관인소，통과 Logistic 회귀분석，탐구상관적위험성인소，위림상치료책략적제정제공의거。방법：회고분석2012년1월-2013년12월본원심혈관내과주원사용뇨격매용전적 AMI 환자86례，근거환자용전치료후혈관시부개통분위개통조47례화미개통조39례，비교량조적일반림상자료。이혈관시부개통위인변량，대가능적상관영향인소포괄 BMI、용전시간、당뇨병、불은정형심교통、흡연이급전벽상관성심기경사진행 Logistic 회귀분석，학정상응적위험인소。결과：86례 AMI 용전환자중，47례혈관성공개통。개통조화미개통조비교，전자적 BMI 교대、용전시간교단、당뇨병환병솔교저、불은정형심교통발생솔교저、흡연비례교고이급전벽상관성심기경사적비례교고。 Logistic 회귀분석적결과발현용전시간>5h、당뇨병、불은정형심교통、비전벽상관성심기경사등4개인소균위혈관개통실패적위험인소。결론：기층의원접진적 AMI 환자약합병당뇨병、기왕유불은정형심교통、용전시간>5 h 혹심기경사부위위비전벽상관성심경시，건의진조전운지상급의원개입중심처리。
Objective: To investigate the related factors that affect intravenous thrombolysis in acute myocardial infarction (acute myocardial infarction, AMI) patients by multivariate Logistic regression analysis. Methods: 86 AMI patients in our cardiology department between January 2012 to December 2013 were included. Based on intravenous thrombolysis result, they were divided into open group (39 cases) or un-open group (47 cases). Their clinical data were retrospective analyzed. The opening situation was considered as dependent variable and possible related factors including BMI, thrombolysis time, diabetes, unstable angina, smoking, and anterior myocardial infarction associated were considered as independent variables. Results: compared the open group and un- open group, the former group was with greater BMI, shorter thrombolysis time, lower diabetes incidence and unstable angina, higher smoking incidence and anterior myocardial infarction. Multivariate Logistic regression analysis results showed that thrombolysis time > 5h, diabetes, unstable angina, non-anterior myocardial infarction were risk factors of open failure.Conclusion: AMI patients with diabetes, unstable angina history, thrombolysis time > 5 h or non-anterior myocardial infarction admitted in primary hospital were better transported to senior hospital.