2025 年第 10 期 第 20 卷

院内心脏骤停在急性心肌梗死合并心源性休克患者中的临床特点及对死亡风险的影响

The clinical characteristics of in-hospital cardiac arrest in patients with acute myocardial infarction complicated with cardiogenic shock and its impact on the risk of death

作者：张静1邵程程1朱佳佳2李江1王粮山3陈立颖4

英文作者：Zhang Jing1 Shao Chengcheng1 Zhu Jiajia2 Li Jiang1 Wang Liangshan3 Chen Liying4

单位：1首都医科大学附属北京安贞医院心脏内科危重症中心一区，北京101118；2首都医科大学附属北京安贞医院心脏内科危重症中心二区，北京100029；3首都医科大学附属北京安贞医院心脏外科重症中心一区，北京101118；4首都医科大学附属北京安贞医院心脏内科，北京101118

英文单位：1Critical Care Center Ward Ⅰ Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 101118 China; 2Critical Care Center Ward Ⅱ Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 3Intensive Care Center Ward Ⅰ Department of Cardiac Surgery Beijing Anzhen Hospital Capital Medical University Beijing 101118 China; 4Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 101118 China

关键词：急性心肌梗死；心源性休克；院内心脏骤停；可复律型心脏骤停；非可复律型心脏骤停

英文关键词：Acutemyocardialinfarction;Cardiogenicshock;In-hospitalcardiacarrest;Shockablecardiacarrest;Nonshockablecardiacarrest

• 摘要：

• 目的 观察在急性心肌梗死合并心源性休克患者中发生院内心脏骤停（IHCA）患者的临床特点，并进一步分析发生IHCA后院内死亡及出院死亡风险。方法 连续纳入2021年9月1日至2024年7月31日就诊于首都医科大学附属北京安贞医院心脏内科危重症中心诊断急性心肌梗死合并心源性休克的患者，对满足纳入标准的患者进行纯观察式研究。根据患者在治疗过程中是否出现IHCA事件对患者进行分组，进一步观察不同组患者临床结局及临床特点并进行对比。首要观察终点为院内死亡；次要观察终点：院内并发症，出院30 d内全因死亡、出院1年内全因死亡。使用Cox回归模型分析IHCA与院内死亡风险关系，使用修正泊松回归分析IHCA对出院30 d、出院1年死亡的影响。结果 本研究共选取患者148例，其中发生IHCA者62例（IHCA组），IHCA发生率为41.9%，其余86例纳入非IHCA组。IHCA组男性比例、血乳酸水平、血管活性药物评分、消化道出血比例均显著高于非IHCA组，左心室射血分数（LVEF）、进行血运重建比例显著低于非IHCA组（均P＜0.05）。IHCA组院内死亡、出院30 d死亡、出院1年死亡比例均显著高于非IHCA组（均P＜0.05）。将62例IHCA患者按照心脏骤停类型分为可复律型心脏骤停（VFCA）组（47例）和非可复律型心脏骤停（NVFCA）组（15例）。NVFCA组出院30 d死亡比例显著高于VFCA组(P＜0.05)。Cox回归模型分析结果显示，与非IHCA组相比，IHCA组院内死亡风险比为2.064(P=0.011)。修正泊松回归分析结果显示，与非IHCA组相比，IHCA组患者出院30 d死亡相对危险度为1.606(P=0.003)，出院1年死亡相对危险度为1.644（P=0.001）；与VFCA组相比，NVFCA组患者出院30 d死亡相对危险度为1.599(P=0.010)，出院1年死亡相对危险度为1.369(P=0.070)。结论 急性心肌梗死合并心源性休克者中IHCA患者血乳酸水平较高，LVEF水平和血运重建比例较低。IHCA导致院内死亡、出院30 d死亡及出院1年死亡风险增高，其中NVFCA导致出院30 d死亡风险增高。

• Objective To observe the clinical characteristics of in-hospital cardiac arrest (IHCA) in patients with acute myocardial infarction complicated with cardiogenic shock, and further analyze the risk of in-hospital death and discharge death after IHCA. Methods Consecutive patients with acute myocardial infarction complicated with cardiogenic shock admitted to the Critical Care Center, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University from September 1, 2021 to July 31, 2024 were enrolled, and the patients who met the inclusion criteria were enrolled in a pure observational study. Patients were divided into groups according to whether IHCA events occurred during the treatment, and the clinical outcomes and clinical characteristics of patients in different groups were further observed and compared. The primary endpoint was in-hospital death. The secondary endpoints included in-hospital complications, all-cause death within 30 d after discharge and all-cause death within 1 year after discharge. Cox regression model was used to analyze the relationship between IHCA and the risk of in-hospital death, and modified Poisson regression was used to analyze the effect of IHCA on death at 30 d and 1 year after discharge. Results A total of 148 patients were selected in this study, of which 62 patients had IHCA (IHCA group), the incidence of IHCA was 41.9%, and the remaining 86 patients were included in the non-IHCA group. The proportion of male, blood lactate level, vasoactive drug score and gastrointestinal bleeding rate in IHCA group were significantly higher than those in non-IHCA group, and the left ventricular ejection fraction (LVEF) and the proportion of revascularization were significantly lower than those in non-IHCA group (all P＜0.05). The in-hospital mortality, 30 d mortality, and 1-year mortality in the IHCA group were significantly higher than those in the non-IHCA group (all P＜0.05). Sixty-two IHCA patients were divided into shockable cardiac arrest (VFCA) group (47 cases) and non-shockable cardiac arrest (NVFCA) group (15 cases) according to the type of cardiac arrest. The 30 d mortality rate in the NVFCA group was significantly higher than that in the VFCA group (P＜0.05). Cox regression model analysis showed that compared with the non-IHCA group, the hazard ratio of in-hospital death in the IHCA group was 2.064 (P=0.011). The results of modified Poisson regression analysis showed that compared with the non-IHCA group, the relative risk of death in the IHCA group was 1.606 (P=0.003) at 30 d after discharge and 1.644 (P=0.001) at 1 year after discharge. Compared with the VFCA group, the relative risk of death in the NVFCA group was 1.599 (P=0.010) at 30 d after discharge and 1.369 (P=0.070) at 1 year after discharge. Conclusion In patients with acute myocardial infarction complicated with cardiogenic shock, blood lactate level is higher, LVEF level and revascularization rate are lower in IHCA patients. IHCA increased the risk of in-hospital death, 30 d death and 1-year death after discharge, and NVFCA increased the risk of 30 d death after discharge.