急性ST段抬高型心肌梗死并发心包积液的相关因素及其对患者预后的影响

闫宇; 王岳松; 王学忠; 董学滨; 邵旭武

doi:10.12125/j.chj.201803045

急性ST段抬高型心肌梗死并发心包积液的相关因素及其对患者预后的影响

Relative factors and clinical prognosis of pericardial effusion in patients with acute ST-segment elevation myocardial infarction

摘要

摘要:
目的探讨急性ST段抬高型心肌梗死(STEMI)患者并发心包积液的影响因素及其对患者预后的影响。

方法因STEMI行直接经皮冠状动脉介入（PCI）治疗的患者274例。根据是否并发心包积液将患者分成两组：心包积液组（55例）和无心包积液组（219例）。观察两组患者临床资料、相关因素及临床预后。

结果 ①基础临床资料：两组患者年龄有统计学差异（P < 0.01），其他包括性别、高血压、糖尿病、高血脂、吸烟、饮酒、冠心病家族史无统计学差异。②冠状动脉病变特征、手术相关事项和其他资料：心包积液组患者发病至入院开通梗死相关血管时间长于无心包积液组（ P < 0.01）,肌酸激酶同工酶（CK-MB）峰值高于无心包积液组（ P < 0.01）,PCI术后左室射血分数（LVEF）低于无心包积液组（ P < 0.01），入院时Killip心功能分级≥Ⅲ级者比例高于无心包积液组（ P < 0.01），PCI术后TIMI血流为2级比例高于无心包积液组，3级比例低于无心包积液组（均 P < 0.01），血栓抽吸和使用糖蛋白Ⅱb /Ⅲa 受体抑制剂( GPI) 比例低于无心包积液组（ P < 0.01, P < 0.05），梗死相关血管为LAD的比例高于无心包积液组（ P < 0.01），平均住院天数长于无心包积液组（ P < 0.01），患者住院期间发生严重心衰和恶性心律失常的比例高于无心包积液组（ P < 0.05）；两组患者PCI术前TIMI血流分级和梗死相关血管为LCX无统计学差异。③随访两组患者6个月内MACE发生情况，心包积液组发生严重心衰的比例和因心源性再住院率高于无心包积液组（ P < 0.05），其他包括恶性心律失常、靶血管再次血运重建、因心源性死亡、心肌梗死后机械并发症、非致死性再发心梗、梗死后心绞痛两组无统计学差异。④对单因素分析中有统计学意义的因素进行多因素logistic回归分析，结果显示：年龄、再灌注治疗时间、使用GPI、血栓抽吸、CK-MB峰值及PCI术后TIMI血流是STEMI患者并发心包积液的独立相关因素。

结论 STEMI患者并发心包积液的相关因素是年龄、再灌注治疗时间、CK-MB峰值、使用GPI、血栓抽吸及PCI术后TIMI血流（前3项正相关，后3项负相关）。并发心包积液患者预后差。

Abstract:
AIM AIM To explore the factors of pericardial effusion in patients with STEMI, and to evaluate the prognosis of these patients.

METHODS Patients with STEMI, a total of 274 cases, who had received coronary artery intervention treatment, and according to the pericardial effusion, they were divided into a pericardial effusion group (n=55) and nonpericardial effusion group (n=219). Clinical characteristics, related factors, and clinical prognosis in the two groups were observed.

RESULTS There were significant differences between the two groups in age (P<0.01). But sex, hypertension, diabetes, hyperlipidemia, smoking, drinking, family history of coronary heart disease (CHD) demmonstrated no statistical difference. There was a differences when comparing time of the patients in the two groups in which the open culprit artery was prolonged (P<0.01), CK-MB peak was higher (P<0.01), left ventricular ejection fraction (LVEF) of PCI postoperative was lower (P<0.01), ratio of heart function Killip≥grade Ⅲ was higher (P<0.01), ratio of TIMI flow grade 2 of PCI postoperative was higher (P<0.01), ratio of thrombus aspiration and using GPⅡb /Ⅲa receptors inhibitors were lower (P<0.01,P<0.05), ratio of patients with the lesion of LAD was higher (P<0.05), average hospitalization days was extended (P<0.01), incidence rate of severe heart failure and malignant arrhythmia were higher while hospitalized (P<0.05). There was no statistical difference in the TIMI flow grade of PCI preoperative and lesion of LCX between the two groups. Incidence rate of MACE after 6 months in both groups showed the pericardial effusion group with high proportion of severe heart failure and rehospitalization related to heart disease (P<0.05), while malignant arrhythmia, target vessel revascularization, cardiac death, postinfarction mechanical complications, non-lethal myocardial infarction, angina pectoris after myocardial infarction were similar. Multiple logistic aggression analysis was performed to assess predictive factors associated with the occurrence of PE complicating STEMI. The results showed that age, reperfusion therapy time, using GPI, thrombus aspiration CK-MB peak, and TIMI flow grade of PCI postoperative were independent factors.

CONCLUSION Relative factors of pericardial effusion in patients with acute ST-segment elevation myocardial infarction were age, reperfusion therapy time, CK-MB peak, using GPI, thrombus aspiration and TIMI flow grade of PCI postoperative. The clinical prognosis of patients with pericardial effusion in patients with acute ST-segment elevation myocardial infarction was poorer.

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