直接经皮冠状动脉介入治疗围手术期发生电风暴的危险因素

The risk factors of perioperative electrical storm in direct percutaneous coronary intervention

目的探讨急性心肌梗死（AMI）患者直接经皮冠状动脉介入治疗（PcI）围手术期发生电风暴的危险因素。方法对41例AMI患者行直接PCI，将围手术期发生电风暴的患者纳入电风暴组，未发生电风暴的患者纳入对照组。电风暴定义：24h内自发的室性心动过速／心室颤动≥2次，并且不能自行终止，需要紧急治疗者。比较两组患者临床资料的差异。结果41例行直接PCI患者中发生电风暴7例（电风暴组），发生率17．07％；未发生电风暴34例（对照组）。两组收缩压、舒张压、白细胞计数、随机血糖、国际标准化比值、胸痛发作至直接PCI时间比较差异均无统计学意义（P〉0．05）。而电风暴组年龄、肌酸激酶同工酶．MB、心肌肌钙蛋白Ⅰ、梗死相关动脉直径、再灌注心律失常发生率以及病死率明显高于对照组（P〈0．05或〈0．01）。梗死相关动脉为左主干或两支主要冠状动脉近中段闭塞、右冠状动脉、左前降支和左回旋支的患者在围手术期电风暴发生率分别为66．67％（2／3）、18．75％（3／16）、11．76％（2／17）和0。结论直接PCI围手术期发生电风暴最常见于梗死相关动脉为左主干或两支主要冠状动脉近中段闭塞的AMI患者。梗死相关动脉直径、梗死相关动脉开通后TIMI血流分级以及再灌注心律失常是围手术期发生电风暴的主要危险因素。

Objective To investigate the risk factors of electrical storm （ES） in patients with acute myocardial infarction （AMI） during perioperative period of direct percutaneous coronary intervention（PCI）. Methods Forty-one AMI patients had been treated with direct PCI. The patients with perioperative ES were included in ES group and those without perioperative ES were included in control group. ES was defined as the occurrence of spontaneous ventricular tachycardia or ventricular fibrillation was twice or more within 24 h and unable to stop by itself and emergency treatment was needed. The difference of the clinical data between two groups were compared. Results There were 7 in 41 patients with direct PCI who had ES,the incidence was 17.07% ,and 34 cases didn＇t have ES. Systolic pressure,diastolic pressure,white cell count,blood glucose,international normalized ratio and time duration from chest pain onset to direct PCI between two groups had no significant differences （P 〉 0.05）. Age,CK-MB,cardiac troponin Ⅰ,the diameter of infarct- related arteries（IRA）, incidence of reperfusion arrhythmia and mortality of ES group were all obviously higher than those of control group （P 〈 0.05 or 〈 0.01 ）. The incidence of ES in patients whose IRA was left main artery or occlusion of middle section of two main coronary arteries, right coronary artery, left anterior de- scending branch and left circumflex artery was 66.67%（2/3）, 18.75%（3/16）, 11.76%（2/17） and 0, re- spectively. Conclusions Perioperative ES during direct PCI most commonly occurrs in AMI patients with left main artery or occlusion of middle section of two main coronary artery. The diameter of IRA,TIMI flow classification after the patency of IRA and recanalization arrhythmia are the main risk factors of the occurrence of perioperative ES.