冠状动脉介入术中并发心室颤动原因分析及随访

RESULTS OF FOLLOW-UP SURVEY AND CLINICAL ANALYSIS OF VENTRICULAR FIBRILLATION DURING CORONARY ANGIOGRAPHY AND INTERVENTION

目的:总结冠状动脉造影、择期经皮冠脉介入治疗(PCI)、急诊PCI术中并发心室颤动(VF)的原因及抢救措施,旨在提出预防措施。方法:2005年1月～2008年12月完成冠状动脉造影、择期PCI、急诊PCI共10800例,其中55例术中并发心室颤动(VF),分析VF发生原因和抢救措施。结果:10800例冠脉介入手术并发VF55例(0.51%),其中冠脉造影术并发VF29例(0.39%),择期PCI术中并发VF9例(0.29%),急性PCI并发VF17例(6.27%)。冠状动脉造影并发VF原因:造影导管超选进入圆锥支10例、造影导管嵌顿9例、气体栓塞6例、冠脉痉挛4例;择期PCI并发VF原因:指引导管嵌顿右冠状动脉开口6例、左主干病2例、球囊加压扩张缺血1例;急诊PCI并发VF原因:再灌注性VF7例、缺血性VF3例、临时搏器电极导致7例;随访结果:1例住院期间死于心源性休克,其余54例进行了12±4月的随访,无VF复发和猝死病例。结论:冠状动脉造影、择期PCI、急诊PCI术中并发心室颤动(VF)的原因及发生率不同。冠脉造影术并发VF与导管操作相关,择期PCI术中并发VF与冠脉严重病变相关;急诊PCI术并发VF与心电不稳定相关。随访无VF复发和猝死病例。

Objective：To summarize the cause and rescue measure of ventrieular fibrillation（VF） complicated in coronary angiography, selective percutaneous coronary intervention （PCI） and emergent percutancous coronary intervention. Method：In 10800 patients from Jan,2005 to Dec ,2008,55 cases of VF were observed. The cause and rescue measures were analyzed. Results：There were 55 （0. 51% ） cases of VF in 10800 patients. There were 29（0. 39% ） cases of VF in 7465 coronary angiography patients,9（0. 29% ） cases of VF in 3064 selective PCI patients , 17（6.27% ） cases of VF in 271 emergent PCI patients,In coronary angiography group, there were 10 cases of angiography catheter super - selective to right conus branch , 9 cases of angiography catheter incarceration , 6 cases of air embolism , 4 cases of coronary artery spasm. In elective PCI group ,there were 6 cases of guiding catheter incarcerated in opening of right coronary artery ,2 cases of left main lesion, 1 case of ischemia caused by balloon inflation. In emergent PCI group, there were 7 eases of reperfusion - induced VF, 3 cases of ischemic VF, 7 cases of VF induced by temporary pacing electrole. During follow- up survey of 12 _＋ 4 months, one patient died of cardiac shock in hospitalization. No sudden death or VF recurrences were observed in other 54 patients. Conclusion： The cause and incidence of ventricular fibrillation were different in coronary angiography, selective PCI and emergent PCI . VF in coronary angiography correlates with catheter manipulation, VF in selective PCI correlates with serious coronary lesions,VF in emergent PCI correlates with cardiac electrical instability. There were no sudden death or VF recurrences during follow -up survey.