急性心肌梗死溶栓后再灌注心律失常的防治

Treatment and Prevention of Reperfusion Arrhythmia after Thrombolytic Therapy for Acute Myocardial Infarction

目的探讨急性心肌梗死（AMI）溶栓后再灌注心律失常（RA）的发病特点及防治对策。方法回顾性分析65例AMI患者溶栓后RA。结果AMI溶栓后RA发病率40％，多发生在胸痛缓解、ST段下移之后持续2-120min。其中加速性室性自主心律（AIVR）发病率占10．9％，心动过缓低血压综合症（BHS）发病率占12．3％，新出现室早或室早增多发病率占10．9％，室颤发病率占6．1％。结论急性心肌梗死（AMI）溶栓治疗后胸痛缓解、ST段下移后应重视RA的发生，严密监护心电变化，对致命性RA应及时治疗。

Objective To study the features of reperfusion arrhythmia（RA） after thrombolytic therapy in acute myocardial infarction （AMI）o Methods Data of the 65 cases of reperfusion arrhythmia after thrombolytic therapy in acute myocardial infarction were retrospective summarized. Results The RA after thrombolytic therapy in AMI mostly occured after remittence of pectoralgia and ST - segment depression and lasted 2 - 120 minutes. Reperfusion arrhythmia took place among 40% of all patients. 10. 9% of them were accelerated idioventricular rhythm （ AIVR）, 12. 3% of them were bradycardia - hypotension syndrome （ BHS ） , 10. 9% of them were new or increased ventricular extrasystole,and 6. 1% of them were ventricular fibrillation. Conclusion Doctors should attach importance to the occuring of reperfusion arrhythmia after thrombolytic therapy especially after remittence of pectoralgia and ST - segment depression, monitor the electrocardiogram changes strictly, and treat the fatal reperfusion arrhythmia in time.