急性心肌梗死患者恶性室性心律失常的发生率及其危险因素分析

The Incidence and Risk Factors of Malignant Ventricular Arrhythmia in Patients with Acute Myocardial Infarction

目的:探讨急性心肌梗死患者恶性室性心律失常(MVA)的发生率及相关危险因素。方法:回顾性分析我院2007年1月—2011年6月急性心肌梗死患者650例,根据动态心电图结果将其分为MVA组和非MVA组,收集患者年龄、性别、吸烟史、高血压、糖尿病、高脂血症、心肌梗死病史、肌酸激酶、肌酸激酶同工酶、肌钙蛋白I、白细胞计数、中性粒细胞计数、血小板计数、血红蛋白、三酰甘油、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、血钾、低血钾例数、血尿素氮、血肌酐、血糖、入院心功能Killip分级、心电图校正的T波峰末间期、心率变异性、直接PCI术开通梗死相关血管例数及恢复期超声结果等指标,比较2组以上指标的差异并进行Logistic回归分析MVA的危险因素。结果:650例急性心肌梗死患者中共有216例(33.2%)发生MVA。Logistic回归分析显示肌酸激酶及肌钙蛋白I升高、低血钾、心功能Killip分级较高、校正的T波峰末间期延长、心率变异性减低、未行直接PCI术开通梗死相关血管、LVEF减低是MVA的危险因素。结论:MVA在急性心肌梗死患者中发病率较高并且是急性心肌梗死患者主要死因之一,对具备以上MVA相关危险因素的患者应足够重视。

Objective： To explore the incidence and risk factors of malignant ventricular arrhythmia （MVA） in patients with acute myocardial infarction. Methods： A retrospective study was performed on 650 patients with acute myocardial infarction from January 2007 to June 2011. According to the Holter outcomes, patients with acute myocardial infarction were divided into MVA group and non-MVA group. The clinical data were recorded including age, gender, history of smoking, hypertension, diabetes, hyperlipidemia, history of myocardial infarction, creatine kinase, creatine kinase isoenzyme, troponin I, white blood cell count, neutrophil count, platelet count, hemoglobin, triglycerides, total cholesterol, low density lipoprotein, high density lipoprotein, potassium, low blood potassium, blood urea nitrogen, serum creatinine, blood glucose, Killip class of cardiac function, corrected Tpeak-Tend interval, heart rate variability, opening of infarct-related artery by direct PCI and ultrasound results of convalescence. The related factors were compared between two groups, and the logistic regression analysis was applied to determine the risk factors for MVA. Results： Among 650 patients, MVA occurred in 216 patients （33.2%）. Logistic regression analysis showed that elevated ereatine kinase and treponin I, low blood potassium, higher Killip class of cardiac function, prolongation of corrected Tpeak-Tend interval, reduced heart rate variability, not opening of infarct-related artery by direct PCI and reduced left ventricular ejection fraction （LVEF） were risk factors of MVA. Conclusion： The incidence of malignant ventricular arrhythmia was higher and was a major cause of death in patients with acute myocardial infarction. Adequate clinical attention should be paid to patients who have the above risk factors of MVA.