本文選題：急性前壁心肌梗死 + 室壁瘤　； 參考：《寧夏醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的分析急性前壁心肌梗死患者出現(xiàn)室壁瘤并發(fā)癥的臨床資料及危險(xiǎn)因素,以早期識(shí)別高�；颊�,為AMI患者早期評(píng)估LVA形成的危險(xiǎn)因素提供補(bǔ)充依據(jù)。方法病例對(duì)照研究。收集寧夏醫(yī)科大學(xué)總醫(yī)院自2010年1月至2016年10月收住心內(nèi)科的急性前壁心肌梗死且有冠狀動(dòng)脈造影資料患者共2602例,其中并發(fā)室壁瘤形成106例,符合納入標(biāo)準(zhǔn)85例為病例組。隨機(jī)選取同一時(shí)間段入院,按年齡、性別匹配無(wú)室壁瘤形成的急性前壁心肌梗死170例為對(duì)照組�？偨Y(jié)并分析室壁瘤形成相關(guān)因素。采用條件Logistic回歸分析急性前壁心肌梗死并發(fā)室壁瘤形成的獨(dú)立危險(xiǎn)因素。結(jié)果本研究共納入85例急性前壁心肌梗死并發(fā)室壁瘤患者,其中男性57例(33.3%),女性28例(33.3%),平均年齡(62.45±11.89)歲;170例急性前壁心肌梗死患者中,男性114例(66.7%),女性56例(66.7%),平均年齡(62.44±11.86)歲。(1)兩組患者年齡、性別、民族、高血壓、糖尿病、高脂血癥、陳舊性心肌梗死、PCI史、冠心病家族史、吸煙史、腦卒中方面均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),臨床基線資料基本一致。(2)LVA組患者入院時(shí)收縮壓升高、竇性心動(dòng)過(guò)速、惡性心律失常及STEMI的發(fā)生率均高于非LVA組,而LVA組梗死前心絞痛發(fā)生率低于非LVA組(均P0.05)。(3)LVA組NT-proBNP、WBC、PLT、UREA、UA水平均較非LVA組高(均P0.05)。(4)LVA組LVEF、FS水平均低于非LVA組(均P0.05),而LVA組LVEDD、LVESD均高于非LVA組(P0.001),LVA組左心室血栓發(fā)生率較非LVA組高(P0.001)。(5)LVA組心功能KillipIII級(jí)、KillipIV級(jí)發(fā)生率均高于非LVA組(均P0.05)。(6)LVA組行急診PCI及側(cè)支循環(huán)建立的發(fā)生率均低于非LVA組(均P0.05);而LVA組單支血管病變、病變血管完全或次全閉塞的發(fā)生率均高于非LVA組(均P0.05)。(7)入院時(shí)收縮壓升高、KillipIII/IV級(jí)、STEMI、單支血管病變、病變血管完全或次全閉塞是LVA事件的獨(dú)立危險(xiǎn)因素,其OR值分別是:5.113、13.008、12.076、6.025、7.296(均P0.05)。而梗死前心絞痛、急診PCI、側(cè)支循環(huán)建立是LVA事件的保護(hù)性因素,OR值分別是:0.196、0.071、0.151(均P0.05)。結(jié)論STEMI患者中室壁瘤發(fā)生率較高。NT-proBNP不僅是心肌壞死和反應(yīng)心功能狀態(tài)的標(biāo)志物,而且對(duì)于LVA的形成具有一定的提示作用。入院時(shí)收縮壓升高、KillipIII/IV級(jí)、STEMI、單支血管病變、梗塞血管完全或次全閉塞是急性前壁心肌梗死后LVA事件的獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective to analyze the clinical data and risk factors of ventricular aneurysm complications in patients with acute anterior wall myocardial infarction (AMI) so as to identify high-risk patients early and provide additional evidence for early evaluation of risk factors of LVA formation in patients with AMI. Methods A case-control study was conducted. From January 2010 to October 2016, 2602 patients with acute anterior myocardial infarction (AMI) and coronary angiography (CAG) were collected from the General Hospital of Ningxia Medical University. 170 patients with acute anterior myocardial infarction without ventricular aneurysm were randomly selected as control group. The factors related to the formation of ventricular aneurysms were summarized and analyzed. Conditional Logistic regression analysis was used to analyze the independent risk factors of ventricular aneurysm formation in acute anterior myocardial infarction. Results A total of 85 patients with acute anterior wall myocardial infarction complicated with ventricular aneurysm were included in this study. Among them, 57 cases were male and 28 cases were female, with an average age of 62.45 鹵11.89 years old and 170 cases with acute anterior wall myocardial infarction. The age, sex, nationality, hypertension, diabetes mellitus, hyperlipidemia, old myocardial infarction history, coronary heart disease family history, smoking history of the two groups were 62.44 鹵11.86 years old (mean age 62.44 鹵11.86) years (n = 114), 66.7% (n = 56), 66.7% (n = 56), and (1) age, sex, nationality, hypertension, diabetes mellitus, hyperlipidemia, coronary heart disease (CHD), family history and smoking history. There was no significant difference in stroke between two groups (P 0.05). The clinical baseline data were basically the same. The systolic blood pressure, sinus tachycardia, malignant arrhythmia and STEMI were higher in the STEMI group than in the non-LVA group, and the incidence of sinus tachycardia, malignant arrhythmia and STEMI were higher than those in the non LVA group. The incidence of pre-infarction angina pectoris in LVA group was lower than that in non-LVA group (all P0.05).(3)LVA group was higher than that in non-LVA group (P0.05).(4)LVA group was lower than non-LVA group (P 0.05), and LVA group was higher than non-LVA group (P 0.001). LVESD was higher than that in non-LVA group.) the incidence of left ventricular thrombosis in P0.05).(3)LVA group was higher than that in non-LVA group (P 0.05). The incidence of left ventricular thrombosis in LVA group was higher than that in non-LVA group (P 0.001). The incidence of left ventricular thrombosis in LVA group was higher than that in non-LVA group. The incidence of KillipIII grade Killip IV of cardiac function in the group of high P0.001 + 5 LVA was higher than that in the group without LVA (the incidence of emergency PCI and collateral circulation establishment in both P0.05).(6)LVA group was lower than that in the non-LVA group (all P 0.05), and the incidence of single vessel disease in LVA group was higher than that in the control group (P < 0.05). The incidence of complete or subtotal occlusion of the diseased vessels was higher than that of the non LVA group (P0. 05, P < 0. 05, P < 0. 05). The risk factors of LVA events were single vessel lesion and total or subtotal occlusion of the diseased vessels. The OR values were respectively 5. 11313. 0013. 0012. 6. 0257.296 (all P 0. 05). The OR of preinfarction angina pectoris, emergency PCI and collateral circulation were 0. 196 0. 071 鹵0. 151 (P < 0. 05), respectively. Conclusion the incidence of ventricular aneurysm in patients with STEMI is relatively high. NT-proBNP is not only a marker of myocardial necrosis and reactive cardiac function, but also a clue to the formation of LVA. Elevated systolic blood pressure (systolic blood pressure) at admission was an independent risk factor for LVA events after acute anterior myocardial infarction (AMI) with single vessel disease and complete or subtotal occlusion of infarcted vessels.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R542.22

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