急性心肌梗死老年患者溶栓抢救失败后机械取栓的影响因素分析

Analysis of influencing factors for mechanical thrombectomy after failed thrombolytic rescue in elderly patients with acute my-ocardial infarction

中文关键词: 老年  急性心肌梗死  机械取栓  溶栓失败  影响因素

英文关键词: elderly  acute myocardial infarction  mechanical thrombectomy  thrombolysis failure  influencing factor

中文摘要:

      目的 探究急性心肌梗死老年患者溶栓抢救失败后机械取栓的影响因素,旨在为提高患者抢救成功率提供依据.方法 回顾性分析2023年1月—2024年8月在柳州市人民医院行溶栓抢救治疗的急性心肌梗死老年患者共242例的临床资料.分析入组患者一般临床特征、心肌梗死病情特征、血脂及血常规特征.采用多因素Logistic回归模型分析影响急性心肌梗死老年患者溶栓抢救失败后机械取栓的影响因素.结果 不同年龄、性别、溶栓前收缩压、舒张压、合并高血压病史情况、发病至溶栓时间、溶栓前血小板分布宽度(PDW)、血小板平均体积(MPV)水平的急性心肌梗死老年患者溶栓失败后机械取栓率比较,差异具有统计学意义(P＜0.05);单因素及多因素Logistic回归分析表明,年龄、高血压病史、发病至溶栓时间、溶栓前PDW、MPV均是急性心肌梗死老年患者溶栓失败后机械取栓的影响因素(P＜0.05).结论 年龄较大、合并高血压病史、发病至溶栓时间较长、溶栓前PDW及MPV水平较高的急性心肌梗死老年患者溶栓抢救失败后机械取栓率较高,针对此类高风险患者应注意改进溶栓抢救方法,以降低溶栓失败率.

英文摘要:

      Objective To investigate the influencing factors for mechanical thrombectomy after failed thrombolytic res-cue in elderly patients with acute myocardial infarction(AMI),and provide a basis for improving the success rate of patient rescue.Methods The clinical data of 242 elderly AMI patients who underwent thrombolytic rescue therapy in People's Hospi-tal of Liuzhou City between January 2023 and August 2024 were retrospectively analyzed.Their general clinical characteristics,AMI features,blood lipid and blood routine test characteristics were analyzed.A multivariate Logistic regression model was used to identify the influencing factors for mechanical thrombectomy after failed thrombolysis in elderly AMI patients.Results There were statistically significant differences in the rate of mechanical thrombectomy after thrombolysis failure among elderly patients with acute myocardial infarction of different ages,genders,pre-thrombolysis systolic blood pressure,diastolic blood pressure,history of hypertension,time from symptom onset to thrombolysis,pre-thrombolysis platelet distribution width(PDW)and mean platelet volume(MPV)levels(P＜0.05).Both univariate and multivariate logistic regression analyses in-dicated that age,history of hypertension,time from symptom onset to thrombolysis,pre-thrombolysis PDW,and pre-thrombol-ysis MPV were all significant influencing factors for mechanical thrombectomy after failed thrombolysis in elderly AMI patients(P＜0.05).Conclusion Elderly AMI patients who are older,and have a history of hypertension,a longer time from onset to thrombolysis and higher levels of PDW and MPV before thrombolysis have a higher rate of mechanical thrombectomy after failed thrombolysis rescue.For these high-risk patients,attention should be paid to improving thrombolytic rescue methods to reduce the failure rate of thrombolysis.