消化道出血合并心肌损伤的危险因素分析

doi:10.3969/j.issn.1002-1949.2019.06.011

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摘要目的消化道出血(gastrointestinal bleeding， GIB)可能会诱发患者发生心肌损伤，从而导致患者的死亡风险增加。本研究旨在探究GIB患者发生心肌损伤的相关危险因素，以期提高临床医生的认识、改善GIB患者的预后。方法回顾性收集中国医学科学院北京协和医院急诊科抢救室2014年1月1日至2015年12月31日收治的GIB患者。根据心肌损伤标准，将GIB患者分为合并心肌损伤组和非心肌损伤组。分别对不同组别患者的人口学资料、临床特征、实验室资料、治疗转归等资料进行单因素及Logistic 回归分析，探究GIB患者发生心肌损伤可能的相关危险因素。结果本研究共纳入219例GIB患者，其中160例患者未合并心肌损伤（非心肌损伤组），59例患者合并心肌损伤（心肌损伤组）。年龄＞65岁、冠心病、心力衰竭、失血性休克、肌酐、白蛋白降低、乳酸升高是GIB合并心肌损伤的危险因素。多因素Logistic回归分析显示，年龄＞65岁（OR=2.141，95%CI1.060~4.324，P=0.034）、合并心力衰竭（OR=6.928，95%CI1.469~32.671，P=0.014）、并发失血性休克（OR=2.156，95%CI1.026~4.531，P=0.043）、白蛋白降低（OR=0.939，95%CI0.886~0.995，P=0.032）可能为GIB合并心肌损伤的独立危险因素。结论在GIB患者中，合并心肌损伤者更常见于高龄患者，且其合并心力衰竭、失血性休克、低蛋白血症的风险更高。

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	姜辉
	张楠
	曹孟孟
	朱华栋

关键词 ：消化道出血(GIB), 心肌损伤, 肌钙蛋白, 急性心肌梗死(AMI)

作者简介: 姜辉（1992-），男，硕士，E-mail：1356060803@qq.com。

引用本文:

姜辉，张楠，曹孟孟，朱华栋. 消化道出血合并心肌损伤的危险因素分析[J]. 中国急救医学, 2019, 39(6): 573-577.
Jiang Hui, Zhang Nan, Cao Meng-meng, Zhu Hua-dong. Risk factor analysis for myocardial injury and prognosis related to gastrointestinal bleeding. Chinese Journal of Critical Care Medicine, 2019, 39(6): 573-577.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2019.06.011 或 http://www.cnemergency.org.cn/CN/Y2019/V39/I6/573

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