【摘要】 目的在接受静脉溶栓治疗的急性心肌梗死病人中研究不同种类溶栓药物对心源性休克的发生风险有无影响。方法研究对象为中山大学附属第一医院和昆明医学院第一附属医院1994—2006年收治的急性ST段抬高型心肌梗死,并接受溶栓治疗的病人。收集病人在入院后72h之内的临床资料,以胸痛发作至心源性休克发生的时间作为因变量,各种潜在的危险因素作为自变量建立Cox生存分析模型,计算各因素在相同时点发生心源性休克的风险函数。结果高龄、男性、有外周动脉疾病史能增加发生心源性休克的风险,溶栓成功、较高的体质指数和平均动脉压能降低心源性休克的风险。广泛前壁心肌梗死病人发生休克的风险高于他部位心肌梗死的患者。溶栓药物种类没有进入Cox回归方程,而溶栓效果与症状发作至溶栓时间的相互作用对心源性休克的发生有影响。结论成功的溶栓治疗能极大降低急性心肌梗死后心源性休克的风险,而该治疗成功的关键在于尽早接受溶栓治疗,不在于溶栓药物种类的选择。更多还原

【Abstract】 Objective The aim of the study was to verify the effect of different thrombolytic agents on the risk of cardiogenic shock(CS) after acute myocardial infarction.Methods Patients of acute ST-segment elevation myocardial infarction who received thrombolytic therapy were enrolled from two Chinese Hospital during 1994 to 2006.Clinical data of each case within 72h after admission were collected.Multivariable Cox regression model was developed to calculate the risk function of CS based on various risk factors.Results Old age,male,and peripheral arterial disease increased the risk of CS.Successful thrombolysis,higher body mass index and mean artery pressure decreased the risk.Patients with extensive anterior myocardial infarction had higher CS risk.Different thrombolytic agents did not contribute to the risk of CS,while the interaction of onset to needle time and thrombolytic effect was involved in the Cox regression model.Conclusion Successful thrombolytic therapy can greatly reduce the risk of cardiogenic shock after acute myocardial infarction.The key to successful thrombolysis is receiving thrombolysis as soon as possible,but not the choice of different thrombolytic agents.更多还原