急性心肌梗死后重症多器官功能衰竭的危险因素：6674例临床分析

Risk factors for severe multiple organ failure in acute myocardial infarction: clinical analysis of 6674 cases

摘要:

目的 探讨急性心肌梗死（AMI）患者发生重症多器官功能衰竭（MOF）的相关危险因素，为临床早期识别高危患者提供依据。方法 对解放军总医院近18年中收治的6674例[18～101岁，平均（62.94±13.63岁）]AMI患者进行回顾性分析，根据是否发生重症MOF分为两组，应用多因素logistic回归分析MOF与患者的年龄、性别、合并症、并发症等的相关性。结果 83（1.24%）例发生了MOF。MOF组住院死亡率明显高于非MOF组（49.40% vs 8.13%，P＜0.001）。年龄（65～74岁，OR＝2.76，95% CI: 1.26～6.03，P＝0.011；≥75岁，OR＝4.85，95% CI: 2.96～7.94，P＜0.001）、肺部感染（OR＝4.27，95% CI: 2.68～6.82，P＜0.001）、心源性休克（OR＝2.24，95% CI: 1.08～4.63，P＝0.030）、慢性肾功能不全（OR＝2.09，95% CI: 1.09～4.01，P＝0.027）是AMI后发生MOF的独立危险因素。受试者工作特征曲线（ROC）下面积为0.83（95% CI: 0.75～0.89，P＜0.001），提示模型有较高的判别MOF患者的能力。结论 MOF在AMI患者中较少见，但严重危害患者预后。积极防治合并症和并发症可有效预防MOF的发生。

Abstract:

Objective To investigate the risk factors for severe multiple organ failure (MOF) in acute myocardial infarction (AMI) patients so as to identify the high-risk patients as early as possible. Methods A retrospective study was carried out on 6674 Chinese AMI patients with a mean age of (62.94±13.63) (ranging from 18 to 101) years who were admitted in our hospital in the past 18 years (from January 1993 to June 2011). They were divided into 2 groups according to having severe MOF or not. Logistic regression analysis was used to analyze the development of severe MOF with demographic and comorbidity variables. Results Of 6674 hospitalized AMI patients, 83(1.24%) progressed to MOF. The hospital mortality was significantly higher in the severe MOF group than in the Non-MOF group (49.40% vs 8.13%, P＜0.001). On the basis of logistic regression analysis, age, pneumonia, cardiogenic shock and chronic renal failure were independent risk factors for severe MOF with an adjusted OR of 2.76 (95% CI: 1.26-6.03, P＝0.011 for 65 to 74 years old), 4.85 (95% CI: 2.96-7.94, P＜0.001 for≥75 years old), 4.27 (95% CI: 2.68-6.82, P＜0.001), 2.24 (95% CI: 1.08-4.63, P＝0.030), and 2.09 (95% CI: 1.09-4.01, P＝0.027), respectively. Receiver-operation characteristic (ROC) curve analysis showed the model had good discriminative ability [area under the curve (AUC)＝0.83, 95%CI: 0.75-0.89, P＜0.001). Conclusion Though MOF is less common in AMI patients, it always results in extremely poor prognosis. For high risk patients, early individual treatments for comorbidity and complication can effectively prevent the occurrence of MOF.