急性ST段抬高型心肌梗死行直接PCI术后再灌注心律失常的临床分析

发布时间：2018-05-30 23:23

本文选题：急性ST段抬高心型肌梗死 + 经皮冠状动脉介入术　；参考：《重庆医学》2016年21期

【摘要】：目的探讨急性ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入术(PCI)时再灌注心律失常(RA)的临床特征。方法选取2010年1月至2014年12月于该院行急诊PCI的STEMI患者148例,根据PCI中是否发生RA分为RA组(71例)与NRA组(77例)。观察患者RA情况,分析梗死相关动脉与RA的关系,观察抬高的ST段回落情况,对比两组患者肌钙蛋白I(TnI)与肌酸激酶同工酶(CK-MB)水平,以及心脏彩超结果。结果左前降支缓慢型心律失常的发生率低于右冠状动脉与左回旋支,而左前降支快速型心律失常发生率高于右冠状动脉与左回旋支,差异均有统计学意义(P0.05)。RA组的开通时间窗及CK-MB达峰时间均早于NRA组,ST段回落幅度、最高TnI及最高CK-MB水平均高于NRA组,差异均有统计学意义(P0.05);48例快速型心律失常患者中,17例经卡多利因静脉滴注或注射后消失,31例未处理心律失常自行消失;23例缓慢型心律失常患者中,16例经静脉注射阿托品后得以控制,3例经安置临时起搏器后1周内得以控制,4例未处理自行消失。术后,RA组主要不良事件总发生率(2.8%)低于NRA组(11.7%),左室射血分数高于NRA组,左室舒张末期内径与左室收缩末期内径低于NRA组,差异均有统计学意义(P0.05)。结论 STEMI患者行PCI时RA的发生率较高,需采取各种有效方法进行积极处理。
[Abstract]:Objective to investigate the clinical features of reperfusion arrhythmia during direct percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods 148 STEMI patients who underwent emergency PCI from January 2010 to December 2014 were divided into RA group (71 cases) and NRA group (77 cases) according to whether RA occurred in PCI. Patients with RA were observed, the relationship between infarction related artery and RA was analyzed, and the elevation of St segment was observed. The levels of troponin I TnI and creatine kinase isoenzyme CK-MBwere compared between the two groups, as well as the results of color Doppler echocardiography. Results the incidence of bradyarrhythmia in left anterior descending branch was lower than that in right coronary artery and left circumflex branch, while the incidence of tachycardia in left anterior descending branch was higher than that in right coronary artery and left circumflex branch. The opening time window and the peak time of CK-MB in group A were earlier than those in group NRA, and the highest TnI and CK-MB levels were higher than those in group NRA. The difference was statistically significant in 48 patients with tachyarrhythmia. Of the 48 patients with tachyarrhythmia, 17 patients disappeared after intravenous drip or injection of cardoin. 31 patients with untreated arrhythmias disappeared spontaneously. Of the 23 patients with bradyarrhythmia, 16 patients were injected intravenously After atropine, 3 cases were controlled by temporary pacemaker and 4 cases disappeared without treatment within 1 week. The total incidence of major adverse events in RA group was lower than that in NRA group (2.8%), left ventricular ejection fraction (LVEF) was higher than that in NRA group, left ventricular end-diastolic diameter and left ventricular end-systolic diameter were lower than NRA group (P 0.05). Conclusion the incidence of RA in STEMI patients with PCI is high.
【作者单位】：贵州省黔东南州人民医院心内科;
【分类号】：R542.22

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