急性心肌梗死再灌注心律失常的临床特点研究

Clinical Analysis of Reperfusion Arrhythmias in Acute Myocardial Infarction

目的探讨急性心肌梗死患者行急诊经皮冠状动脉介入(PCI)或经皮冠状动脉成行(PTCA)术再灌注心律失常的临床特点。方法对我科2008年1月—2012年3月78例急诊PCI和10例急诊PTCA患者的资料进行回顾性分析,分析急性心肌梗死患者在行急诊PCI或PTCA时再灌注心律失常的发生情况、采取的相关处理方法及最终心律失常的转归,以便于掌握再灌注心律失常的特点,达到降低急诊PCI术的病死率。结果本组发生再灌注心律失常68例(其中室性心律失常52例,缓慢性心律失常16例),再灌注心律失常发生率为77.2%。88例患者梗死相关动脉经血运重建血管均再通,其中行PCI(PTCA+STENT)术76例,单纯行PTCA术12例;死亡1例,是支架后无复流发生所致。结论急诊PCI术时再灌注心律失常发生率较高,特别要警惕室性心律失常及严重的缓慢性心律失常的发生,在术前已有心律失常患者要给与相关药物应用,对于下壁心肌梗死患者术前已有缓慢性心律失常者,应给予安装临时起搏器保护。

Objective To discuss the clinical features of acute myocardial infarction patients undergoing emergency percutancous coronary intervention （PCI） or pereuteneous coronary line （PTCA） of the clinical features of reperfusion arrhythmi- as. Methods Retrospective analysis from January 2008 to March 2012, the information of our department 78 cases of primary PCI and 10 cases of emergency PTCA patients were analyzed retrospectively to analyze patients with acute myocardial infarction the line when emergency PCI （PTCA） repeffusion rhythm disorders, as well as taken by the methods of treatment efficacy, in order to grasp the characteristics of repcrfusion arrhythmias, which can reduce the mortality of primary PCI. Results This group of reperfusion arrhythmias occurred in 68 cases （including 52 cases of ventricular arrhythmia, 16 cases of slow arrhythmla）, occur- rence of reperfusion arrhythmia in 77. 2%. In 88 patients with the infarction related artery blood vessels were recanalization revas- cularization, which PCI （PTCA ＋STENT） in 76 cases, simple PTCA procedure in 12 cases; 1 cases died, is the support of no - reflow occurs. Conclusion The primary PCI reperfusion higher incidence of arrhythmia, in particular to be alert to the occur- rence of ventricular arrhythmlas, and severe bradycardia, arrhythmia to give applications and related drugs before surgery, infe- rior wall myocardial infarction in patients with surgery prior to the slow arrhythmia, sbeuld be given to install the protection of temporary pacemaker.