急诊入院急性冠脉综合征患者近期预后的危险因素分析
Risk factors for short-term prognosis in patients with acute coronary syndrome admitted to emergency department

刘刚.急诊入院急性冠脉综合征患者近期预后的危险因素分析[J].内科急危重症杂志,2019,25(6):470-474

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DOI：10.11768/nkjwzzzz20190609

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基金项目:湖北省重点科学基金（No: 2014CFA061）

作者	单位	E-mail
刘刚	湖北省荆州市第三人民医院	2155906510@qq.com

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中文摘要:

目的: 探讨影响急诊入院急性冠脉综合征(ACS)患者近期预后的危险因素。方法: 回顾性分析胸痛、胸闷急诊入院的154例患者的临床资料。根据出院后1个月内是否死亡分为存活组(134例)与死亡组(20例)，采用多因素Cox回归分析影响急诊入院ACS患者近期预后的危险因素。结果:死亡组患者年龄较存活组大\[(76.0±11.3）岁 vs (62.5±10.3)岁, P<0.01\]，合并糖尿病的患者比例较存活组明显增加（35.0% vs 18.7%，P<0.05）；平均住院时间显著短于存活组\[(5.0±5.3)d vs (12.3±6.0)d，P<0.01\]；胸痛就诊时间显著长于存活组\[(12.3±6.0)d vs (5.0±5.3)d，P<0.05\]。死亡组患者舒张压水平较存活组显著下降（P<0.05），心率较存活组增快（P<0.01），脑钠肽（BNP）水平及心肌肌钙蛋白（cTnI）最高值均较存活组增高(P<0.01或P<0.05)。Cox多因素回归〖JP2〗分析发现，年龄(OR:95%CI, 1.134:1.061~1.212, P<0.001)、院前心脏骤停(OR:95%CI, 8.946: 1.607~49.815,P=0.012)、舒张压(OR:95%CI, 0.965: 0.938~0.994, P= 0.016)、心率(OR:95%CI, 1.049:1.020~1.079, P=0.001)、胸痛就诊时间(OR:95%CI, 1.023: 1.002~1.045, P=0.032)是影响急诊入院ACS患者近期预后的危险因素。结论：年龄较大、院前心脏骤停、胸痛就诊时间较长、舒张压低、心率快是影响急诊入院ACS患者近期预后的危险因素。

英文摘要:

Objective: To investigate the risk factors affecting the short-term prognosis of acute coronary syndrome (ACS) patients admitted in the emergency department. Methods: A retrospective analysis was performed on 154 patients admitted to hospital for diagnosis of ACS due to chest pain and chest tightness. The patients were divided into survival group (n=134) and death group (n=20) according to death or not 1 month after discharge. The multivariate Cox regression analysis was used to analyze the risk factors of the short-term prognosis in patients with ACS during emergency admission. Results: The patients in the death group were significantly older \[(76.0±11.3) years vs (62.5±10.3)years, P<0.01\] and the death group had a significantly greater proportion of diabetes mellitus than in the survival group (35.0% vs 18.7%, P < 0.05). The average length of hospital stay in the death group was significantly shorter than that in the survival group \[(5.0 ± 5.3)days vs (12.3 ± 6.0) days, P<0.01\]. Delay in chest pain in the death group was significantly longer than in the survival group \[(12.3 ± 6.0) days vs (5.0 ± 5.3) days, P<0.05\]. The diastolic blood pressure in the death group was significantly lower than that in the survival group (P<0.05). The heart rate in the death group was faster than that in the survival group (P<0.01). Both the BNP level and the highest cTnI value in the death group were higher than those in the survival group (P<0.05 or P<0.01). Cox multivariate regression analysis revealed that age (OR:95% CI, 1.134:1.061-1.212, P<0.001), prehospital cardiac arrest (OR:95% CI, 8.946:1.607-49.815, P=0.012), diastolic blood pressure (OR:95% CI, 0.965:0.938-0.994, P=0.016), heart rate (OR:95% CI, 1.049:1.020-1.079, P=0.001), and delay in chest pain (OR:95% CI, 1.023:1.002-1.045, P=0.032) were the risk factors influencing the short-term prognosis of ACS patients admitted in the emergency department. Conclusions: Older age, prehospital cardiac arrest, longer duration of chest pain, lower diastolic blood pressure, and faster heart rate are all risk factors that affect the short-term prognosis of ACS patients admitted in the emergency department.