摘要
目的 探究急性ST段抬高型心肌梗死(ASTEMI)患者冠状动脉溶栓后心肌缺血再灌注损伤(MIRI)现状及影响因素。方法 选择2019年1月—2022年7月保定市第二中心医院收治的行冠状动脉溶栓治疗的ASTEMI患者(227例)为研究对象;根据治疗后是否继发MIRI,分为MIRI组(65例)和非MIRI组(162例)。对比分析两组患者的一般资料、影像学资料以及实验室指标。多因素Logistic回归分析危险因素,构建结构方程模型(SEM)并评价。结果 右冠状动脉主干(RCA)梗死、下壁梗死、治疗前收缩压(SBP)<90 mmHg、治疗前舒张压(DBP)<60 mmHg、冠状动脉狭窄率高以及脑钠肽(BNP)、肌酸激酶同工酶(CK-MB)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)水平上升,均是MIRI发生的独立危险因素(P<0.05)。SEM整体适配度较好,能很好地反映各指标与MIRI的关系。总效应统计结果显示,影像学资料、实验室指标对MIRI发生影响较大,各回归路径均有统计学意义(P<0.05)。结论 RCA梗死、下壁梗死、治疗前SBP<90 mmHg、治疗前DBP<60 mmHg、冠状动脉狭窄率高以及BNP、CK-MB、TC、TG、LDL-C水平上升,均是ASTEMI患者冠状动脉溶栓后MIRI发生的独立危险因素。
Objective To explore the status quo and influencing factors of myocardial ischemia reperfusion injury(MIRI)in patients with acute ST-segment elevation myocardial infarction(ASTEMI)after coronary thrombolysis.Methods ASTEMI patients(227 cases)admitted to The Second Central Hospital of Baoding from January 2019 to July 2022 who underwent coronary artery thrombolysis therapy were selected as the study subjects,According to whether MIRI occurs after treatment,they are divided into MIRI group(65 cases)and non MIRI group(162 cases).The general information,imaging data,and laboratory indicators of the two groups of patients were compared and analyzed.Multivariate Logistic regression analysis of risk factors,construction of structural equation model(SEM)and evaluation.Results Right coronary artery(RCA)infarction,inferior wall infarction,pre treatment systolic blood pressure(SBP)<90 mmHg,pre treatment diastolic blood pressure(DBP)<60 mmHg,high rate of coronary artery stenosis,and increased levels of brain natriuretic peptide(BNP),creatine kinase-MB(CK-MB),total cholesterol(TC),triglyceride(TG)and low density lipoprotein cholesterol(LDL-C)were independent risk factors for MIRI(P<0.05).The SEM has good overall adaptability and can well reflect the relationship between various indicators and MIRI.The total effect statistical results showed that imaging data and laboratory indicators had a significant impact on MIRI,and all regression paths had statistical significance(P<0.05).Conclusion RCA infarction,inferior wall infarction,pre treatment SBP<90 mmHg,pre treatment DBP<60 mmHg,high coronary stenosis rate,and elevated levels of BNP,CK-MB,TC,TG and LDL-C are independent risk factors for MIRI in ASTEMI patients after coronary thrombolysis.
作者
张宁
张玉
崔国旺
索佳蕾
索蒲霞
ZHANG Ning;ZHANG Yu;CUI Guowang;SUO Jialei;SUO Puxia(Department of Medical Services,the Second Central Hospital of Baoding,Baoding Hebei 071000,China)
出处
《中国急救复苏与灾害医学杂志》
2025年第6期715-718,共4页
China Journal of Emergency Resuscitation and Disaster Medicine
基金
保定市科技计划项目(编号:2241ZF193)。
关键词
急性ST段抬高型心肌梗死
冠状动脉溶栓治疗
缺血再灌注损伤
影响因素分析
Acute ST-segment elevation myocardial infarction
Coronary thrombolytic therapy
Myocardial ischemia reperfusion injury
Influencing factors analysis
