2018 年第 9 期 第 13 卷

急性心肌梗死合并心源性休克患者IABP-SHOCK_Ⅱ评分对院内死亡风险的预测价值

Predictive value of IABP-SHOCK Ⅱ score for in-hospital mortality in patients with acute myocardial infarction complicated with cardiac shock

作者：魏小红刘文娴

英文作者：

单位：100029首都医科大学附属北京安贞医院心内科重症监护室

英文单位：

关键词：急性心肌梗死；心源性休克；院内死亡

英文关键词：

• 摘要：

• 【摘要】目的    探讨IABP-SHOCK Ⅱ评分对急性心肌梗死合并心源性休克患者院内死亡风险的预测价值。方法    选择首都医科大学附属北京安贞医院2009—2015年收治的完成急诊经皮冠状动脉介入（PCI）治疗的急性心肌梗死合并心源性休克患者114例，根据IABP-SHOCK Ⅱ评分分为低危组(0~2分)、中危组(3~4分)、高危组(5~9分)，比较3组患者的梗死相关情况、主动脉内球囊反搏使用情况及院内病死率，并利用受试者工作特征曲线分析该危险分层方法对患者院内转归的预测价值。结果    114例患者根据IABP-SHOCK Ⅱ评分分为低危组55例、中危组50例、高危组9例，3组患者心肌梗死部位及闭塞病变情况比较差异均无统计学意义（均P>0.05）；高危组PCI术后心肌梗死溶栓试验（TIMI）血流分级3级的比例低于低危组和中危组［3/9比96.4%（53/55）、74.0%（37/50）］，中危组低于低危组，差异均有统计学意义（均P＜0.05）；高危组应用主动脉内球囊反搏辅助的比例高于低危组及中危组［8/9比63.6%（35/55）、58.0%（29/50）］（均P＜0.05）；高危组院内病死率高于低危组和中危组［6/9比12.7%（7/55）、36.0%（18/50）］，中危组高于低危组，3组间比较差异均有统计学意义（均P＜0.05）。IABP-SHOCK Ⅱ评分预测急性心肌梗死合并心源性休克患者院内死亡的受试者工作特征曲线下面积为0.728，标准误为0.057（P＜0.001）。结论    IABP-SHOCK Ⅱ评分对完成急诊PCI治疗的急性心肌梗死合并心源性休克患者院内死亡的预测价值较高。

• 【Abstract】Objective    To assess the value of IABP-SHOCK Ⅱ score in prediction of in-hospital mortality in patients with acute myocardial infarction complicated with cardiac shock. Methods    From 2009 to 2015, 114 cases of acute myocardial infarction complicated with cardiac shock who underwent percutaneous coronary intervention(PCI) in Beijing Anzhen Hospital, Capital Medical University were included. According to the IABP-SHOCK Ⅱ score, the patients were divided into low risk group(IABP-SHOCK Ⅱ score 0-2), medium risk group(IABP-SHOCK Ⅱ score 3-4) and high risk group(IABP-SHOCK Ⅱ score 5-9). Myocardial infarction characteristics, use of intra-aortic balloon pump and in-hospital mortality were recorded. The predictive value of IABP-SHOCK Ⅱ risk stratification for in-hospital outcomes was analyzed by receiver operating characteristic(ROC) curve. Results    There were 55 cases in the low risk group, 50 cases in the medium risk group and 9 cases in the high risk group. There was no significant difference of myocardial infarction site and vessel occlusion among groups（P>0.05）. Rate of thrombolysis in myocardial infarction（TIMI） flow grade 3 after PCI in the high risk group was significantly lower than that in the low risk and medium risk groups［3/9 vs 96.4%（53/55）, 74.0%（37/50）］（P＜0.05）. Use rate of intra-aortic balloon pump in the high risk group was significantly higher than that in the low risk and medium risk groups［8/9 vs 63.6%（35/55）, 58.0%（29/50）］（P＜0.05）. In-hospital mortality in the high risk group was significantly higher than that in the low risk and medium risk groups［6/9 vs 12.7%（7/55）, 36.0%（18/50）］; there was also a significant difference between the low risk and medium risk groups（P＜0.05）. Area under ROC curve of IABP-SHOCK Ⅱ score in predicting in-hospital mortality was 0.728 and the standard error was 0.057（P＜0.001）. Conclusion    IABP-SHOCK Ⅱ score shows a good value in prediction of in-hospital mortality in acute myocardial infarction patients with cardiac shock after PCI.