急性心肌梗死早期室性心律失常相关因素分析

Factors Related to Ventricular Arrhythmia Complicating Acute Phase of Myocardial Infarction

目的:探讨急性心肌梗死(AMI)早期各类室性心律失常(VA)的相关因素和对近期预后的影响。方法:161例确诊为AMI患者。根据心电记录将VA分为5组。单发室性早搏组(单发室早组,10例);成对,二联律的室性早搏组(成对室早组,21例);非持续性室性心动过速组(非持续室速组,31例);室性心动过速,心室颤动组(室速室颤组,11例);对照组88例。每位均接受了冠状动脉造影,超声心动图检查。结果:左主干病变在室速室颤组较对照组发生率显著升高,差异具有统计学意义(P<0.05);右冠状动脉病变发生率在非持续室速组较对照组显著增高,差异具有统计学意义(P<0.05);梗死相关血管再通未达到心肌梗死溶栓治疗临床试验(TIMI)Ⅲ级发生率在室速室颤组较对照组显著增高,差异具有统计学意义(P<0.05);三支血管存在大于70%冠状动脉狭窄病变发生率在室速室颤组较对照组显著增高,差异具有统计学意义(P<0.05);左心室射血分数在室速室颤组较对照组明显降低,差异具有统计学意义(P<0.01)。30天病死率室速室颤组与对照组比较,差异具有统计学意义(P<0.05)。结论:AMI早期发生的各类VA中,室速室颤的发生影响患者近期预后。持续性室速室颤发生的相关因素为梗死相关血管为左主干病变,再通血流未达到TIMIⅢ级,多支血管病变和左心室射血分数明显降低。

To explore the related factors of ventricular arrhythmia （VA） complicating acute phase of myocardial infarction and their effects on short term prognosis. Methods： A total of 161 subjects with acute myocardial infarction （AMI） were divided into 5 groups according to VA types： frequent single ventricular premature beat group （n = 10）, bigeminy or paired ventricular premature beat group （n=21）, non-sustained ventricular tachycardia group （ n = 31 ） , ventricular tachycardia and fibrillation group （ n = 11 ） and control group （ n = 88 ）. The characteristics of coronary artery and left ventricular ejection fraction were determined. Results： The incidence of left main coronary occlusion was more frequent in ventricular tachycardia and fibrillation group than in control group （P〈0.05）. Right coronary artery occlusion occurred more often in non-sustained ventricular tachycardia group （ P 〈 0. 05 ）. Low TIMI class was more commonly found in ventricular tachycardia and fibrillation group than in control group（ P 〈 0. 05 ）. Three-vessel disease was more commonly found in ventricular tachycardia and fibrillation group （ P 〈 0. 05 ）. Left ventricular ejection fraction was significantly low in ventricular tachycardia and fibrillation group （P 〈0. 01 ）. There was sta- tistic difference in 30-day mortality rate between ventricular tachycardia and fibrillation group and control group （P〈 0. 05 ）. Conclusions ： Ventricular tachycardia and fibrillation complicating acute phase of myocardial infarction can affect short-term prognosis. The related factors of ventricular tachycardia and fibrillation of early AMI were left main coronary artery occlusion, failed revascularization,3-vessel disease and low ventricular ejection fraction.