急性心肌梗死伴新发心房纤颤的临床分析

Clinical analysis of acute myocardial infarction with new cases of atrial fibrillation

目的研究探讨急性心肌梗死(AMI)伴新发心房纤颤(AF)的临床特点。方法回顾性分析344例急性心肌梗死患者住院期间的资料,其中新发房颤患者53例(AF组),未发生房颤者291例(NAF组),AF组按新发AF持续时间分为AF1组23例(心肌梗死24 h内发生AF者),AF2组30例(心肌梗死24 h后发生AF者)。比较AF组和NAF组之间的年龄、并发症、CK-MB峰值、心功能(Killp分级)、死亡率以及NAF组和AF1组、AF2组之间心肌梗死部位病变血管情况等因素的对比。结果 AF组老年患者多于NAF组(P<0.01),AF伴有高血压病、糖尿病者高于NAF组(P<0.01),AF组CK-MB峰值、心力衰竭发生率、死亡率显著高于NAF组(P<0.01),AF组冠状动脉多支病变的发生率较NAF组高(P<0.05),AF1组下壁AMI发生率高于NAF组和AF2组(P<0.05),AF2组前壁AMI发生率高于AF1组(P<0.05)。结论高龄、伴发高血压、糖尿病、梗死面积及多支血管病变是AMI并新发AF的危险因素,AF发生时间与AMI梗死部位相关,AMI并新发AF者严重并发症多,预后差,应给予早期积极干预。

Objective To study the clinical features of acute myocardial infarction （AMI） with new cases of atrial fibrilla tion （AF）. Methods Three hundred and forty-four cases of acute myocardial infarction patients in hospital were studied, the patients were divided into new cases of 53 patients with atrial fibrillation （AF group） and 291 patients with no atrial fibrilla tion （NAF group）, AF group was divided into two subgroups according to the onset time of AF, in AF1 group, AF developed within 24 hours after the onset AMI, in AF2 group, AF developed more than 24 hours after the onset AMI, the age, com- plications, CK-MB peak, and cardiac function （Killp hierarchical） and mortality were contrasted between AF group and the NAF group, parts of myocardial infarction and vascular lesions of the factors were contrasted between NAF group and AF1, AF2 group. Results The advanced age of patients in AF group was higher than that in NAF group（P 〈 0.01）, AF hypertension disease, diabetes in AF group were more than the NAF group （P 〈 0.01）, CK-MB peak, incidence of heart failure and death rate in AF group was higher than those of the NAF group（P 〈 0.01）, coronary artery muhivessel disease incidence of AF group was higher than that of NAF group （P 〈 0.05）. The lower wall AMI incidence in AF1 group was higher than that of NAF group and AF2 group （P 〈 0.05）, the anterior wall AMI incidence in AF2 group was higher than that of NAF group and AF1 group （P 〈 0.05）. Conclusion Advanced age, with hypertension disease, diabetes, infarction area and a more diffuse and severe narrowing and vascular lesions are risk factors of AMI with AF, AF occurrence time is related to AMI in- farction parts, AMI with new cases of AF have serious complications and poor prognosis, early positive intervention should be given.