急性心肌梗死后合并持续性心动过速、心室颤动患者院内死亡的相关因素

发布时间：2018-03-20 20:42

本文选题：急性心肌梗死　切入点：室性心动过速　出处：《广东医学》2017年08期 　论文类型：期刊论文

【摘要】：目的探讨急性心肌梗死(AMI)后合并持续性室性心动过速(VT)、心室颤动(VF)患者院内死亡的相关因素。方法回顾性分析确诊AMI合并持续性VT/VF的57例患者的临床资料,包括入院时患者的年龄、性别;既往高血压病史、糖尿病病史,是否有陈旧性心肌梗死,是否吸烟;心肌梗死症状发作至持续性VT/VF发生的时间;入院时的心电图指标包括QT间期、矫正的QT间期(QTc)、J波、碎裂QRS波;血生化指标包括血清钾离子浓度、血肌酐浓度;心脏彩色多普勒超声心动图指标包括左室射血分数、左室舒张末期内径。结果院内死亡23例,存活出院34例。AMI后合并持续性VT/VF患者平均年龄(62±12)岁,男45例(78.9%),急性前壁心肌梗死36.8%,多部位心肌梗死18.6%。院内死亡组的平均年龄高于存活出院组(P=0.025),AMI症状发生到出现持续性VT/VF的间隔时间明显长于存活出院组(P=0.006)。院内死亡组的左室射血分数低于存活出院组(P=0.018)。院内死亡组碎裂QRS波阳性率明显高于存活出院组(39.1%vs 8.8%,P=0.009),血肌酐水平高于存活出院组(P=0.003)。有碎裂QRS波的患者复律除颤失败率明显高于无碎裂QRS波的患者(41.7%vs 13.3%,P=0.011);有碎裂QRS波的患者平均Killip分级明显高于无碎裂QRS波的患者,差异有统计学意义(P=0.028)。碎裂QRS波等临床指标与院内死亡关系的多因素logistic回归分析显示Killip分级[OR=1.904,95%CI=1.257~3.875,P=0.024],AMI发生到出现持续性VT/VF的间隔时间[OR=1.160,95%CI=1.010~1.032,P=0.028],碎裂QRS波[OR=2.570,95%CI=2.013~4.215,P=0.032]具有统计学意义。结论 AMI合并持续性VT/VF的院内死亡的危险性与Killip分级相关,Killip分级越高患者的院内死亡率越高,AMI症状发生到出现持续性VT/VF的间隔时间越长。住院期间出现碎裂QRS波也提示患者心脏受损更加严重,电生理紊乱难以逆转,最后导致患者院内生存率的降低。
[Abstract]:Objective to investigate the related factors of hospital death in patients with persistent ventricular tachycardia (VT) and ventricular fibrillation (VF) after acute myocardial infarction (AMI). Methods the clinical data of 57 patients with AMI complicated with persistent VT/VF were retrospectively analyzed. Age, sex, history of hypertension, diabetes mellitus, old myocardial infarction, smoking, time between onset of myocardial infarction symptoms and persistent VT/VF were included. The ECG parameters at admission included QT interval, corrected QT interval QTc / J wave, broken QRS wave, serum biochemical parameters including serum potassium ion concentration, serum creatinine concentration, cardiac color Doppler echocardiography index including left ventricular ejection fraction, left ventricular ejection fraction (LVEF), left ventricular ejection fraction (LVEF), left ventricular ejection fraction (LVEF), serum potassium ion concentration and serum creatinine concentration. Results 23 cases died in hospital, 34 cases survived and discharged. The average age of patients with persistent VT/VF after AMI was 62 卤12 years old. 45 male patients with acute anterior wall myocardial infarction (AMI) and acute anterior wall myocardial infarction (AMI) were 36. 8% and 18. 6% respectively. The average age in the hospital death group was higher than that in the alive and discharged group. The interval between the onset of symptoms and the occurrence of persistent VT/VF was significantly longer than that in the alive and discharged group. The positive rate of QRS wave in the dead group was significantly higher than that in the alive group (39. 1 vs 8. 8%), and the serum creatinine level was higher than that in the alive discharge group. The failure rate of defibrillation in the patients with QRS wave was significantly higher than that in the patient with QRS wave. The average Killip grade of patients with QRS waves without fragmentation was significantly higher than that with QRS waves without fragmentation. The multivariate logistic regression analysis of the relationship between QRS wave and hospital mortality showed that the Killip grade [OR1.904 / 95CI1.2573.875P0.024] had statistical significance to the interval between the occurrence of VT/VF and the occurrence of persistent VT/VF [OR1. 160 / 95CI1.0101.032 P0.028], and the fragmentation of QRS wave [OR2.57095CI2.0134.215P0.032] had statistical significance. The risk of hospital death in patients with AMI complicated with persistent VT/VF and the higher the Killip grade associated with Killip grade, the higher the hospital mortality, the longer the interval between the onset of symptoms and the occurrence of persistent VT/VF. The fragmentation of QRS waves during hospitalization was also observed. It shows that the patients' heart damage is more serious. It is difficult to reverse the electrophysiological disorder, which leads to the decrease of the hospital survival rate.
【作者单位】：东莞市人民医院心血管内科;
【基金】：东莞市卫生局科研资助项目(编号:20136609)
【分类号】：R541.7;R542.22

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