广州医科大学学报

目的:探讨影响基层医院急性心肌梗死(acute myocardial infarction,AMI)患者静脉溶栓效果的相关因素,通过Logistic回归分析,探究相关的危险性因素,为临床治疗策略的制定提供依据。方法:回顾分析2012年1月-2013年12月本院心血管内科住院使用尿激酶溶栓的AMI患者86例,根据患者溶栓治疗后血管是否开通分为开通组47例和未开通组39例,比较两组的一般临床资料。以血管是否开通为因变量,对可能的相关影响因素包括BMI、溶栓时间、糖尿病、不稳定型心绞痛、吸烟以及前壁相关性心肌梗死进行Logistic回归分析。确定相应的危险因素。结果:86例AMI溶栓患者中,47例血管成功开通。开通组和未开通组比较。前者的BMI较大、溶栓时间较短、糖尿病患病率较低、不稳定型心绞痛发生率较低、吸烟比例较高以及前壁相关性心肌梗死的比例较高。Logistic回归分析的结果发现溶栓时间>5h、糖尿病、不稳定型心绞痛、非前壁相关性心肌梗死等4个因素均为血管开通失败的危险因素。结论:基层医院接诊的AMI患者若合并糖尿病、既往有不稳定型心绞痛、溶栓时间>5 h或心肌梗死部位为非前壁相关性心梗时.建议尽早转运至上级医院介入中心处理。

Objective:To investigate the related factors that affect intravenous thrombolysis in acute myocardial infarction(acute myocardial infarction,AMI) patients by multivariate Logistic regression analysis.Methods:86 AMI patients in our cardiology department between January 2012 to December 2013 were included.Based on intravenous thrombolysis result,they were divided into open group(39 cases) or un-open group(47cases).Their clinical data were retrospective analyzed.The opening situation was considered as dependent variable and possible related factors including BMI,thrombolysis time,diabetes,unstable angina,smoking,and anterior myocardial infarction associated were considered as independent variables.Results:compared the open group and un- open group,the former group was with greater BMI,shorter thrombolysis time,lower diabetes incidence and unstable angina,higher smoking incidence and anterior myocardial infarction.Multivariate Logistic regression analysis results showed that thrombolysis time > 5h,diabetes,unstable angina,non-anterior myocardial infarction were risk factors of open failure.Conclusion:AMI patients with diabetes,unstable angina history,thrombolysis time>5 h or non-anterior myocardial infarction admitted in primary hospital were better transported to senior hospital.