| 张玉卓,凌学斌,林燕仔,朱厚玲.急性心梗患者PCI术中并发心室纤颤的影响因素及Gensini评分、血钾对其预测价值[J].,2020,(20):3956-3960 |
| 急性心梗患者PCI术中并发心室纤颤的影响因素及Gensini评分、血钾对其预测价值 |
| Influential Factors of Ventricular Fibrillation During PCI in Patients with Acute Myocardial Infarction and Its Predictive Value by Gensini Score and Serum Potassium |
| 投稿时间：2020-03-28 修订日期：2020-04-23 |
| DOI：10.13241/j.cnki.pmb.2020.20.034 |
| 中文关键词: AMI PCI VF 血钾 Gensini评分 |
| 英文关键词: AMI PCI VF Serum potassium Gensini score |
| 基金项目:海南医学院培育基金项目（201645） |
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| 中文摘要: |
| 摘要 目的：探讨分析AMI患者PCI术中并发VF的影响因素以及冠脉Gensini评分、血钾对其预测价值。方法：从2016年6月至2019年6月于我院就诊的AMI患者中筛选出356例，对其临床资料进行回顾性分析。以AMI患者PCI术中是否并发VF为依据进行组别划分，分为VF组（49组）、NVF组（未并发VF，307例）。整理比较两组一般资料、临床资料，并对两组患者冠脉造影特征、冠脉Gensini评分作对比分析，对AMI患者PCI术中并发VF的可疑性影响因素行多因素Logistic回顾分析，以确定其危险因素，并对危险因素行ROC曲线分析以确定其预测价值。结果：VF组和NVF组在性别、年龄、吸烟史、饮酒史、高血压史、糖尿病史、既往应用β受体阻滞剂及阿司匹林，入院时收缩压和心率方面，均无统计学差别（P>0.05），临床血指标检测上，VF组血钾水平明显低于NVF组，差异具有统计学意义（P<0.05），冠脉造影检查显示VF组TIMI血流0级、Gensini积分高及血栓负荷重例数高于NVF组，差异具有统计学意义（P<0.05）。多因素Logistic回归分析显示TIMI血流分级0级、血钾、Gensini评分为AMI患者PCI术中并发VF的独立危险因素（P<0.05）。ROC曲线分析结果显示，TIMI血流分级0级、血钾、Gensini评分均对AMI患者PCI术中并发VF具有一定的预测价值，其ROC曲线下面积分别为0.619、0.816、0.842（P值均＜0.05），提示血钾、Gensini评分具有中等预测价值，TIMI血流分级0级预测价值较低。当血钾、Gensini评分分别处4.05、89.95最佳截断值时，其敏感度分别为100%、63.3%，特异度分别为为41.8%、94.1%。结论：TIMI血流分级0级、血钾、Gensini评分为AMI患者PCI术中并发VF的独立危险因素。TIMI血流分级0级、血钾、Gensini评分均对AMI患者PCI术中并发VF具有一定的预测价值。血钾、Gensini评分具中等预测价值，TIMI血流分级0级预测价值较低。 |
| 英文摘要: |
| ABSTRACT Objective: To analyze the influencing factors of VF during PCI in patients with AMI and the predictive value of coronary Gensini score and blood potassium. Methods: From June 2016 to June 2019, 356 patients with AMI who were treated in our hospital were selected and their clinical data were retrospectively analyzed. Groups were divided according to whether VF was complicated during PCI in AMI patients. They were divided into VF group (49 groups) and NVF group (no concurrent VF, 307 patients). The general and clinical data of the two groups were collated and compared, and the coronary angiographic characteristics and coronary Gensini scores of the two groups were analyzed. The suspicious influencing factors of VF during PCI in patients with AMI were analyzed by multi-factor Logistic retrospective analysis to determine The risk factors are analyzed by ROC curve analysis to determine its predictive value. Results: The general data (gender, age, smoking history, drinking history, hypertension history, diabetes history, previous beta blockers and aspirin use, systolic blood pressure and heart rate at admission) were not significantly different between the two groups (P>0.05). In terms of clinical indicators, only the potassium level was significantly lower in the VF group than in the NVF group, and the difference was statistically significant (P<0.05). In terms of coronary angiography characteristics, there was a significant difference in the TIMI blood flow classification between the two groups, and the difference was statistically significant (P<0.05), suggesting that the AMI patients in the VF group were more severe than the NVF group; the proportion of high thrombus load in the VF group It was significantly higher than the NVF group, and the difference was statistically significant (P<0.05). In terms of Gensini score, the VF group was significantly higher than the NVF group, and the difference was statistically significant (P<0.05). Based on the comparison of the above two groups, blood potassium, TIMI blood flow classification, high thrombus load, and Gensini score are suspicious influencing factors of VF during PCI in AMI patients, and then multivariate logistic regression analysis is performed on related suspicious influencing factors. The results showed that TIMI blood flow grade 0, blood potassium, and Gensini scores were independent risk factors for VF in patients with AMI during PCI (P<0.05). ROC curve analysis results show that TIMI blood flow grade 0, potassium, and Gensini scores have certain predictive value for VF during PCI in patients with AMI. The area under the ROC curve is 0.619, 0.816, 0.842, and 95% CI, respectively. The values were 0.541 ~ 0.696, 0.756 ~ 0.876, 0.779 ~ 0.905, and the P values were 0.008, 0.000, and 0.000, respectively, suggesting that the potassium potassium and Gensini scores have medium predictive value, and the TIMI blood flow grade 0 predictive value is low. When the serum potassium and Gensini scores were at the best cutoff values of 4.05 and 89.95, the sensitivity was 100%, 63.3%, and the specificity was 41.8%, 94.1%. Conclusion: TIMI blood flow grade 0, potassium, and Gensini scores are independent risk factors for VF in patients with AMI during PCI. TIMI blood flow grade 0, potassium, and Gensini scores have certain predictive value for VF in patients with AMI during PCI. The serum potassium and Gensini scores have medium predictive value, and the TIMI blood flow grade level 0 has lower predictive value. |
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