CAJ | 학술논문

目的：分析急诊行经皮冠状动脉介入术（PCI）治疗的急性心肌梗死患者术后发生低血压的危险因素。方法将我院收治的急诊行 PCI 治疗的急性心肌梗死患者165例分为术后低血压组和术后非低血压组两组，统计分析性别、年龄、高血压病、糖尿病、高血脂症、术前血压情况、心肌梗死病变位置等因素与低血压发生的相关性。结果165例急诊行 PCI 治疗的急性心肌梗死患者中 PCI 术后低血压发生率为38．8％。PCI 术后低血压组中出现心肌缺血症状的患者显著低于 PCI 术后非低血压患者（21．9％ vs 48．5％，P ＜0．01）。PCI 术后低血压组肌酸激酶同工酶 MB （CK-MB）峰值显著高于非低血压组，（247．3±186．8）U／L vs （175．4±159．6）U／L（P ＜0．05）。PCI 术后低血压患者下壁心肌梗死和右室心肌梗死的患者均明显高于非低血压患者（62．5％ vs 28．7％，P ＜0．01；12．5％ vs 4．0％，P＜0．05）。冠状动脉造影显示 PCI 术后低血压患者中完全闭塞、近段病变、右冠状动脉病变均高于术后非低血压患者（P ＜0．05）。PCI 术后低血压患者术后 TIMI 分级＜2级比例显著高于术后非低血压患者，差异有统计学意义（71．88％ vs 4．95％，P ＜0．05）。对 PCI 术后患者低血压的危险因素进行 logistic 回归分析结果表明，心肌缺血症状是 PCI 术后患者低血压的保护性因素，而右冠状动脉病变、近段病变、完全闭塞、术后 TIMI 分级＜2级均为 PCI 术后患者低血压的危险因素（P ＜0．05）。结论出现心肌缺血症状是 PCI 术后低血压发生的保护性因素，而右冠状动脉病变、近段病变、完全闭塞、术后 TIMI 分级＜2级均为 PCI 术后患者低血压的危险因素，应该引起临床医生的高度重视。
목적：분석급진행경피관상동맥개입술（PCI）치료적급성심기경사환자술후발생저혈압적위험인소。방법장아원수치적급진행 PCI 치료적급성심기경사환자165례분위술후저혈압조화술후비저혈압조량조，통계분석성별、년령、고혈압병、당뇨병、고혈지증、술전혈압정황、심기경사병변위치등인소여저혈압발생적상관성。결과165례급진행 PCI 치료적급성심기경사환자중 PCI 술후저혈압발생솔위38．8％。PCI 술후저혈압조중출현심기결혈증상적환자현저저우 PCI 술후비저혈압환자（21．9％ vs 48．5％，P ＜0．01）。PCI 술후저혈압조기산격매동공매 MB （CK-MB）봉치현저고우비저혈압조，（247．3±186．8）U／L vs （175．4±159．6）U／L（P ＜0．05）。PCI 술후저혈압환자하벽심기경사화우실심기경사적환자균명현고우비저혈압환자（62．5％ vs 28．7％，P ＜0．01；12．5％ vs 4．0％，P＜0．05）。관상동맥조영현시 PCI 술후저혈압환자중완전폐새、근단병변、우관상동맥병변균고우술후비저혈압환자（P ＜0．05）。PCI 술후저혈압환자술후 TIMI 분급＜2급비례현저고우술후비저혈압환자，차이유통계학의의（71．88％ vs 4．95％，P ＜0．05）。대 PCI 술후환자저혈압적위험인소진행 logistic 회귀분석결과표명，심기결혈증상시 PCI 술후환자저혈압적보호성인소，이우관상동맥병변、근단병변、완전폐새、술후 TIMI 분급＜2급균위 PCI 술후환자저혈압적위험인소（P ＜0．05）。결론출현심기결혈증상시 PCI 술후저혈압발생적보호성인소，이우관상동맥병변、근단병변、완전폐새、술후 TIMI 분급＜2급균위 PCI 술후환자저혈압적위험인소，응해인기림상의생적고도중시。
ABSTRACT:Objective To analyze the risk factors of hypotension after emergency percutaneous coronary intervention(PCI)in acute myocardial infraction patients.Methods Various clinical parameters were retrospectively analyzed in 165 acute myocardial infraction patients with emergency PCI in the hospital.The patients were divided into the hypotension group and non-hypotension group according to the occurrence of hypotension or not after emergency PCI.The observation indexes included gender,age,hypertension,diabetes,hyperlipemia,preoperative blood pressure and lesion location of acute myocardial infraction.Results The incidence of hypotension after operation in 165 acute myocardial infraction patients with emergency PCI was 38.8%. In the hypotension group, the patients who experienced symptoms of myocardial ischemia were obviously less than the non-hypotension group (21.9% vs 48.5%, P <0.01 ).Compared with non-hypotension group,the peak value of creatine kinase isomer-MB(CK-MB)in the hypotension group was significantly decreased (247.3 ± 186.8)U/L vs (175.4 ± 159.6)U/L(P < 0.05).In the hypotension group, the patients with acute inferior myocardial infarction (IMI) or right ventricular myocardial infarction(RVMI)were apparently more than non- hypotension group (IMI 62.5% vs 28.7%,P < 0.01;RVMI 12.5% vs 4.0%,P < 0.05).Coronary angiography showed that in the hypotension group,the incidences of total occlusion,proximal stenosis and stenosis in the right coronary artery were significantly more than non-hypotension group(P < 0.05).There were significant difference in the lesion types between two groups(P < 0.05).Logistic regression analysis showed that the symptom of myocardial ischemia was the protective factor against hypotension after operation,while total occlusion,proximal stenosis and stenosis in the right coronary artery and the TIMI grading after operation were the risk factors of hypotension after operation (P <0.05).Conclusion Inferior myocardial infarction or right ventricular myocardial infarction,total occlusion,proximal stenosis and stenosis in the right coronary artery and the TIMI grading after operation could increase the possibility of hypotension after PCI.The symptom of myocardial ischemia could reduce the incidence of hypotension after PCI.