2021 年第 12 期 第 16 卷

老年急性ST段抬高型心肌梗死患者经皮冠状动脉介入术后心肌内出血的危险因素分析

Risk factors of intramyocardial hemorrhage after percutaneous coronary intervention in elderly patients with acute ST-segment elevation myocardial infarction

作者：罗一纯1简能日1李如利2

英文作者：Luo Yichun1 Jian Nengri1 Li Ruli2

单位：1四川大学华西医院放射科，成都610000；2川北医学院附属医院心内科，四川省南充市637800

英文单位：1Department of Radiology West China Hospital Sichuan University Chengdu 610000 China; 2Department of Cardiology Affiliated Hospital of North Sichuan Medical College Sichuan Province Nanchong 637800 China

关键词：

英文关键词：AcuteST-segmentelevationmyocardialinfarction;Percutaneouscoronaryintervention;Intramyocardialhemorrhage

• 摘要：

• 目的 探讨老年急性ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入（PCI）术后心肌内出血（IMH）的相关危险因素。方法 选取四川大学华西医院于2019年1月至2020年12月行PCI术的老年急性STEMI患者175例作为研究对象，依据术后是否发生IMH分为IMH组（58例）与无IMH组（117例）。采用多因素Logistic回归方法分析术后IMH发生的独立危险因素。结果  单因素分析结果显示，IMH组前壁心肌梗死、闭塞冠状动脉开通时间＞45 min、三支病变和肾功能不全比例均高于无IMH组，差异均有统计学意义（均P＜0.05）。多因素Logistic回归分析显示，前壁心肌梗死、闭塞冠状动脉开通时间＞45 min、三支病变和肾功能不全为行PCI术的老年急性STEMI患者术后发生IMH的独立危险因素（比值比=4.356、6.982、9.954、2.932，95%置信区间：1.894～7.235、2.743～10.212、3.942～13.546、1.382～5.461，P=0.029、0.012、0.004、0.035）。结论  老年STEMI患者PCI术后IMH发生率较高，且受多因素影响。心肌梗死部位、闭塞冠状动脉开通时间、病变支数和肾功能不全为其独立危险因素。

• Objective To investigate the risk factors of intramyocardial hemorrhage (IMH) after percutaneous coronary intervention (PCI) in elderly patients with acute ST-segment elevation myocardial infarction (STEMI). Methods From January 2019 to December 2020, 175 elderly patients with acute STEMI who underwent PCI in West China Hospital, Sichuan University were selected. According to whether IMH occurred after operation, they were divided into IMH group (58 cases) and non IMH group (117 cases). Multivariate Logistic regression analysis was used to analyze the independent risk factors of postoperative IMH. Results The univariate analysis showed that the rates of anterior myocardial infarction, occlusive coronary opening time ＞45 min, triple vessel lesions and renal insufficiency in the IMH group were higher than those in the non IMH group (all P＜0.05). Multivariate Logistic regression analysis showed that anterior myocardial infarction, occlusive coronary opening time ＞45 min, triple vessel lesions and renal insufficiency were independent risk factors for postoperative IMH in elderly patients with STEMI（odds ratio=4.356, 6.982, 9.954, 2.932， 95% confidence interval：1.894-7.235, 2.743-10.212, 3.942-13.546, 1.382-5.461， P=0.029, 0.012, 0.004, 0.035）. Conclusions   The incidence of IMH after PCI in elderly patients with STEMI is high, and it is affected by many factors. The location of myocardial infarction, the opening time of occlusive coronary artery, the number of coronary lesions and renal insufficiency are the independent risk factors for the patients.