2020 年第 8 期 第 15 卷

右冠状动脉病变所致急性下壁ST段抬高型心肌梗死患者左心衰竭的危险因素

Risk factors of acute inferior ST segment myocardial infarction with left heart failure caused by right coronary artery disease

作者：平英瑶1 赵明君2 宋发亮2 刘勤社2

英文作者：Ping Yingyao1 Zhao Mingjun2 Song Faliang2 Liu Qinshe2

单位：1陕西中医药大学2017级中西医结合临床专业在读硕士研究生，陕西省咸阳市712046；2陕西中医药大学附属医院心内科，陕西省咸阳市712046

英文单位：1Postgraduate Student Grade 2017 Integrated Traditional Chinese and Western Medicine Shaanxi University of Traditional Chinese Medicine Shaanxi Province Xianyang 712046 China; 2Department of Cardiology Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine Shaanxi Province Xianyang 712046 China

关键词：右冠状动脉；急性下壁ST段抬高型心肌梗死；左心衰竭；高危因素

英文关键词：Rightcoronaryartery;AcuteinferiorSTsegmentelevationmyocardialinfarction;Leftheartfailure;Highriskfactors

• 摘要：

• 目的 探讨右冠状动脉病变所致急性下壁ST段抬高型心肌梗死患者发生左心衰竭的影响因素。方法 选取陕西中医药大学附属医院2013年1月至2018年1月收治的534例右冠状动脉病变所致急性下壁ST段抬高型心肌梗死患者作为研究对象，回顾性分析患者临床病历资料，将发生左心衰竭者（162例）作为观察组，未发生左心衰竭者（372例）作为对照组。比较2组患者临床资料，分析右冠状动脉病变所致急性下壁ST段抬高型心肌梗死患者发生左心衰竭的危险因素。结果 观察组患者女性、高血压、糖尿病、冠状动脉粥样硬化性心脏病史、房室传导阻滞、导联ST段压低、V4～6导联ST段压低、肺部渗出、使用利尿剂、使用临时起搏器、缺血事件、心律失常比例，高敏C反应蛋白、胱抑素C、血肌酐、血尿素氮和入院、住院、出院时的N末端B型脑钠肽前体和第3天补液量水平均明显高于对照组，而吸烟比例、入院时收缩压、舒张压和入院后经皮冠状动脉介入比例明显低于对照组，差异均有统计学意义（均P＜0.05）。多因素Logistic回归分析结果显示，女性、高血压、高敏C反应蛋白、入院时低舒张压、血肌酐、以V4～6导联ST段压低为主是右冠状动脉病变所致急性下壁ST段抬高型心肌梗死患者发生左心衰竭的高危因素（比值比=18.560、8.333、25.716、2.314、3.133、4.712，95%置信区间：2.183～42.022、1.224～22.869、3.176～56.372、1.264～17.624、2.064～4.756、1.754～18.666，均P＜0.001）。结论 右冠状动脉病变所致急性下壁ST段抬高型心肌梗死患者左心衰竭发生率较高，女性、高血压、高敏C反应蛋白、入院时低舒张压、血肌酐、以V4～6导联ST段压低为主是患者发生左心衰竭的高危因素。

• Objective To investigate the influencing factors of left heart failure in patients with acute inferior ST segment elevation myocardial infarction caused by right coronary artery disease. Methods Totally 534 patients with acute inferior ST segment myocardial infarction caused by right coronary artery disease from January 2013 to January 2018 admitted to the Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine were selected. According to medical history, patients with left heart failure (162 cases) were selected as the observation group and patients without left heart failure (372 cases) were as the control group. The clinical data was analyzed including the risk factors of left heart failure in patients with acute inferior ST segment myocardial infarction caused by right coronary artery. Results In observation group, the proportion of female, history of hypertension, diabetes, coronary atherosclerotic heart disease, atrioventricular block, lead ST segment depression, V4-6 lead ST segment depression, pulmonary exudation, use of diuretics and temporary pacemakers, ischemic events, arrhythmias, the levels of high-sensitivity C-reactive protein, Cystatin C, blood creatinine, blood urea nitrogen and B-type pro brain natriuretic peptide before, during and after admission, fluid supplement on the third day were significantly higher than those in control group; the proportion of smoking, the levels of systolic blood pressure, diastolic blood pressure and percutaneous coronary intervention after admission were significantly lower than those in control group (P＜0.05). Multivariate logistic regression analysis showed that female, hypertension, high sensitive C-reactive protein, low diastolic pressure before admission, serum creatinine, and ST segment depression in lead V4-6 were the high risk factors of left heart failure in patients with acute inferior wall ST segment elevation myocardial infarction caused by right coronary artery（odds ratio=18.560, 8.333, 25.716, 2.314, 3.133, 4.712, 95% confidence interval: 2.183-42.022, 1.224-22.869, 3.176-56.372, 1.264-17.624, 2.064-4.756, 1.754-18.666, all P＜0.001）. Conclusion Patients with acute inferior ST-segment elevation myocardial infarction caused by right coronary arteries show a high rate of left heart failure; female, hypertension, high-sensitivity C-reactive protein, low diastolic pressure before admission, blood creatinine, mainly V4-6 lead ST segment depression are the risk factors of left heart failure.