2021 年第 10 期 第 16 卷

休克指数与急性ST段抬高型心肌梗死患者近期预后的关系

Relationship between shock index and short-term prognosis in patients with acute ST segment elevation myocardial infarction

作者：陈乐武冬郭筱王

英文作者：Chen Le Wu Dong Guo Xiaowang

单位：陕西省人民医院急诊内科，西安710068

英文单位：Department of Emergency Medicine Shaanxi Provincial People′s Hospital Xi′an 710068 China

关键词：急性ST段抬高型心肌梗死；致死性心脏不良事件；休克指数；危险因素；预测价值

英文关键词：AcuteSTsegmentelevationmyocardialinfarction;Fataladversecardiacevents;Shockindex;Riskfactors;Predictivevalue

• 摘要：

• 目的  探讨急性ST段抬高型心肌梗死（STEMI）患者休克指数与近期预后的关系。方法 选取2018年8月至2020年8月于陕西省人民医院就诊的STEMI患者153例作为研究对象，按院内是否发生致死性心脏不良事件分为预后良好组(96例)和预后不良组(57例)。比较2组患者休克指数及其他临床资料的差异，分析患者发生致死性心脏不良事件的危险因素，检测休克指数对致死性心脏不良事件的预测价值。结果 预后不良组患者的冠心病家族史、心肌梗死史、Killip分级Ⅱ～Ⅳ级比例和体重指数均明显高于预后良好组(均P＜0.05)。预后不良组患者的心率及休克指数明显高于预后良好组［（89±16）次/min比（82±12）次/min、（0.85±0.24）比（0.64±0.16）］，收缩压、舒张压及平均动脉压明显低于预后良好组［（105±23）mmHg（1 mmHg=0.133 kPa）比（127±19）mmHg、（64±14）mmHg比（71±17）mmHg、（78±17）mmHg比（90±18）mmHg］(均P＜0.05)。多因素Logistic回归分析显示心肌梗死史、Killip分级Ⅱ～Ⅳ级、休克指数升高及收缩压降低是发生致死性心脏不良事件的独立危险因素(均P＜0.05)。休克指数预测急性STEMI患者发生致死性心脏不良事件的曲线下面积为0.799(95%置信区间：0.723～0.876)，最佳预测值为0.83，约登指数为0.624，敏感度和特异度分别为73.90%、88.50%。结论 休克指数、心肌梗死病史及较差Killip分级是STEMI患者发生致死性心脏不良事件的独立危险因素，且休克指数的预测价值较高，临床中可据此尽早评估患者病情以改善患者预后。

• Objective To investigate the relationship between shock index and short-term prognosis in patients with acute ST segment elevation myocardial infarction (STEMI). Methods From August 2018 to August 2020, 153 STEMI patients admitted to Shaanxi Provincial People′s Hospital were enrolled. According to whether fatal adverse cardiac events occurred in the hospital, patients were divided into good prognosis group (96 cases) and poor prognosis group (57 cases). The differences of shock index and other clinical data of the two groups were compared, the risk factors of fatal adverse cardiac events were analyzed, and the predictive value of shock index for fatal adverse cardiac events was detected. Results The proportion of family history of coronary atherosclerotic heart disease, myocardial infarction history, Killip grade Ⅱ-Ⅳ and body mass index in the poor prognosis group were significantly higher than those in the good prognosis group (all P＜0.05). The heart rate and shock index in the poor prognosis group were significantly higher than those in the good prognosis group［（89±16）times/min vs （82±12）times/min, （0.85±0.24） vs （0.64±0.16）］, while the systolic blood pressure, diastolic blood pressure and mean arterial pressure in the poor prognosis group were significantly lower than those in the good prognosis group［（105±23）mmHg vs （127±19）mmHg, （64±14）mmHg vs （71±17）mmHg, （78±17）mmHg vs （90±18）mmHg］(all P＜0.05). Multivariate Logistic regression analysis showed that myocardial infarction history, Killip grade Ⅱ-Ⅳ, the increase of shock index and the decrease of systolic blood pressure were independent risk factors for fatal adverse cardiac events (all P＜0.05). The area under the curve for predicting fatal adverse cardiac events with shock index was 0.799 (95% confidence interval: 0.723-0.876), the best predictive value was 0.83, the Youden index was 0.624, and the sensitivity and specificity were 73.90% and 88.50%, respectively. Conclusions  Shock index, myocardial infarction history and poor Killip grade are independent risk predictors of fatal adverse cardiac events in STEMI patients. The prediction value of shock index is high, so it can be used as early as possible to evaluate patients′ condition and improve their prognosis.