摘要
目的探讨老年急性心肌梗死患者并发心源性休克的危险因素及预后。方法回顾性分析2020年1月至2023年12月沈阳市第十人民医院重症医学科收治的急性心肌梗死患者398例,根据住院期间是否发生心源性休克分为心源性休克组99例和对照组299例。比较2组临床特征,分析心源性休克的危险因素,并探讨心源性休克对患者预后的影响。结果与对照组比较,心源性休克组年龄≥80岁、糖尿病、冠状动脉病变支数≥2支、冠状动脉左主干病变、既往心肌梗死病史比例显著增高(P<0.05,P<0.01)。年龄≥80岁、糖尿病、冠状动脉病变支数≥2支、冠状动脉左主干病变、既往心肌梗死病史是老年急性心肌梗死患者并发心源性休克的独立危险因素(OR=2.280,95%CI:1.294~4.017,P=0.004;OR=2.326,95%CI:1.281~4.225,P=0.006;OR=3.868,95%CI:2.145~6.975,P=0.000;OR=3.587,95%CI:1.868~6.886,P=0.000;OR=4.040,95%CI:1.951~8.365,P=0.000)。根据相关危险因素,构建预测模型,训练集ROC曲线下面积为0.799(95%CI:0.736~0.862),验证集ROC曲线下面积为0.737(95%CI:0.634~0.840)。对验证集模型进行Hosmer-Lemeshow拟合优度检验(χ^(2)=7.117,P=0.524),说明本模型具有较好的可信度。与对照组比较,心源性休克组院内病死率显著升高(12.12%vs 0.67%,P=0.000)。结论心源性休克可导致老年急性心肌梗死患者预后不良,年龄≥80岁、糖尿病、冠状动脉病变支数≥2支、冠状动脉左主干病变、既往心肌梗死病史是心源性休克的独立危险因素。
Objective To explore the risk factors and prognosis of cardiogenic shock in elderly patients with acute myocardial infarction(AMI).Methods A retrospective trial was conducted on 398AMI patients admitted to our hospital from January 2020to December 2023.Based on occurrence of cardiogenic shock during hospitalization or not,they were divided into a cardiogenic shock group(n=99)and a control group(n=299).Clinical characteristics were compared between the two groups to analyze the risk factors of cardiogenic shock,and the impact of cardiogenic shock on the prognosis was investigated.Results The cardiogenic shock group had significantly larger proportions of aged≥80years,diabetes,coronary artery lesion≥2branches,left main coronary artery disease,history of myocardial infarction than the control group(P<0.05,P<0.01).Aged≥80years,diabetes,diseased branches≥2,left main artery disease and history of myocardial infarction were independent influencing factors of cardiogenic shock in elderly AMI patients(OR=2.280,95%CI:1.294-4.017,P=0.004;OR=2.326,95%CI:1.281-4.225,P=0.006;OR=3.868,95%CI:2.145-6.975,P=0.000;OR=3.587,95%CI:1.868-6.886,P=0.000;OR=4.040,95%CI:1.951-8.365,P=0.000).Based on these relevant risk factors,aprediction model was constructed.The AUC value of the model in the training set was 0.799(95%CI:0.736-0.862),while the value for the validation set was 0.737(95%CI:0.634-0.840).Hosmer-Lemeshow Goodness of Fit test showed the model had good reliability(χ2=7.117,P=0.524).The in-hospital mortality rate was significantly higher in the cardiogenic shock group than the control group(12.12%vs 0.67%,P=0.000).Conclusion Cardiogenic shock can lead to poor prognosis in elderly AMI patients.Aged≥80years,diabetes,diseased branches≥2,left main artery disease and history of myocardial infarction are independent risk factors for cardiogenic shock.
作者
李海宁
陈伟
Li Haining;Chen Wei(Department of Critical Care Medicine,Shenyang Tenth People's Hospital,Shenyang110044,Liaoning Province,China)
出处
《中华老年心脑血管病杂志》
CAS
北大核心
2024年第5期518-522,共5页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
关键词
心肌梗死
休克
心源性
危险因素
预后
回顾性研究
myocardial infarction
shock,cardiogenic
risk factors
prognosis
retrospective studie
