急性心肌梗死并发心房纤颤的临床特点

Clinical characteristics of acute myocardial infarction complicated with arterial fibrillation

目的探讨急性心肌梗死(AM I)并发心房纤颤(AF)的临床特点。方法回顾性分析341例AM I患者住院期间资料,其中新发AF者33例(AF组),未发生AF者308例(NAF组),AF组依照AF发生时间分为AF1组13例(AM I发病24 h内出现AF者),AF2组20例(AM I发病24 h后现出AF者)。比较AF组和NAF组之间的年龄、并发症、心功能、病死率及NAF组和AF1组、AF2组之间心肌梗死部位的不同。结果AF组老年患者多于NAF组(69.7%vs 52.9%,P<0.01),伴有高血压病、糖尿病多于NAF组(分别为57.6%vs 39.9%、27.3%vs 13.0%,均P<0.01),AF组心衰发生率、病死率高于NAF组(63.6%vs 31.8%、27.3%vs 10.7%,均P<0.01):AF1组下壁AM I发生率显著高于NAF组和AF2(69.2%vs 40.9%和30.0%,均P<0.05),AF2组前壁AM I发生率显著高于AF1组(60.0%vs15.3%,P<0.05)。结论高龄、高血病、糖尿病是AM I并发AF的危险因素,AF发生时间与AM I梗死部位有关,AM I并发AF者预后更差,应予积极干预。

Objective To investigate the clinical characteristics of acute myocardial infarction complicated with arterial fibrillation. Methods 341 patients with acute myocardial infarction were studied, the patients were divided into AF（ arterial fibrillation）group and NAF（ no arterial fibrillation）group. AF group was divided into two subgroups according to the onset time of AF,in AF1 group, AF dveloped within 24 hours after the onset of AMI ; in AF2 group, AF dveloped more than 24 hours after the onset of AMI. The age, complications, cardiac function, mortality rate were compared between two groups. Results The average age of patients in AF group was higher than that in NAF group（69. 7% vs 52. 9% ,P 〈 0. 01 ）. More patients with complications of hypertension of diabetes were in NAF group（57.6%vs 39. 9% ,27.3%vs 13.0% ,P 〈0.01 ,the occurrence of acute inferior myocardial infarction was hihger in AF1 group than that in NAF and AF2 group（69. 2% vs 40. 9% and 30.0% ,P 〈 0. 05 ）, the occurrence of anterior myocardial infarction was hihger in AF2 group was higher than that in AF1 group（60. 0% vs15.3%, P 〈 0. 05 ）. Conclusion Risk factors for the acute myocardial infarction complicated with arterial fibrillation include age, hypertension, diabetes, the occurrence of AF is related to the location of infarction, the prognosis is poor for patients with acute myocardial infarction complicated with arterial fibrillation.