急性心肌梗死伴阵发房颤的临床研究

A Clinical Study of Acute Myocardial Infarction with Paroxysmal Atrial Fibrillation

目的:探讨急性心肌梗死(AMI)合并阵发心房颤动(AF)患者AF复发的影响因素。方法:将120例AMI伴阵发AF患者,在随访1年期间依有无AF复发分为复发组和窦性心律(窦律)组,比较2组一般资料、病史、血清C反应蛋白(CRP)水平、低密度脂蛋白胆固醇(LDL-C)水平、左房内径(LAD)、左室射血分数(LVEF),评价心功能,同时比较不同治疗方法患者间的AF复发率。结果:复发组年龄、心功能分级、患高血压和前壁心肌梗死高于或多于窦律组,LVEF低于窦律组,LAD大于窦律组(P<0.05或P<0.01)。溶栓再通患者AF复发率低于未溶或未再通患者,服用他汀患者AF复发率低于未服用他汀患者(均P<0.05)。高龄、高血压病、前壁梗死、高CRP水平、LAD增大和心功能减退是AF复发的危险因素;溶栓再通、服用他汀是抑制AF复发的保护性因素(P<0.05或P<0.01)。结论:高龄、高血压、前壁梗死、LAD增大、心功能减退促使AF的复发;早期血运重建、应用他汀类药物可抑制AF复发。

Objective：To investigate the clinical factors influencing the atrial fibrillation（AF） recurrence in patients with acute myocardial infarction（AMI） combined paroxysmal AF.Methods：One hundred and twenty patients with AMI and AF were divided into two groups,the recurrence group and the normal sinus rhythm（NSR） group based on with or without the AF recurrence during the one year follow-up.The general information and medical history were compared between the patients of the two groups.At the end of the one-year follow-up,the levels of C-reactive protein（CRP）,low-density lipoprotein（LDL-C）,left atrial diameter（LAD） and left ventricular ejection fraction（LVEF） were detected in patients.The recurrence ratios of AF were compared in patients with different treatment methods.Results：The average age,cardiac function,hypertension and anterior myocardial infarction were significantly higher in patients of recurrence group than those of NSR group（P 0.01）.The value of LVEF was lower,LAD was larger in patients of NSR group than those of recurrence group（P 0.05 or P 0.01）.There was a significantly lower recurrence rate of AF in patients with successful intravenous thrombolysis and with treatment of statins compared with that of patients without the application of intravenous thrombolysis,failure to reperfusion or without treatment of statins（P 0.01）.Binary logistic analysis showed that age,hypertension,anterior myocardial infarction,high level of CRP,LAD enlargement and cardiac dysfunction increased the risk for the recurrences of AF（P 0.05 or P 0.01）,and that revascularization and treatment with statins were the preventive measures against the recurrence of AF（P 0.05）.Conclusion：Precipitating factors for the recurrence of AF included senior age,hypertension,anterior wall infarction,LAD enlargement and cardiac dysfunction.Therefore,early revascularization and treatment with statins are effective measures against the recurrence of AF.