溶栓抗凝治疗急性心肌梗死伴发重复再灌注心律失常临床分析

Clinical analysis of re-reperfusion arrhythmia during thrombolytic therapy for acute myocardial infarction

目的 分析溶栓治疗急性心肌梗死时重复再灌注心律失常的发生情况及意义。方法 随机选择急性心肌梗死溶栓治疗再通病例 30例 (再通组 ) ,溶栓治疗未再通病例 15例 (非再通组 )。溶栓药物尿激酶 ,每例 15 0万 u溶于生理盐水 10 0 ML ,30分钟内静脉滴入。治疗前后测心肌酶谱 ,两组病例均在溶栓后做冠状动脉造影。结果 下壁心肌梗死 15例中 8例在首次发生再灌注心律失常后 5 0± 10分钟 ,出现与首次心律失常相似但程度不同的心律失常 ,本组病例多表现为一度或二度房室传导阻滞 (AVB) ,但这一重复心律失常 ,严重程度及持续时间均较首次再灌注心律失常轻和短。 15例非再通组下壁心梗 9例中有 5例发生 AVB,发生时间与溶栓治疗无关 ,持续时间长。结论 溶栓治疗急性心肌梗死时出现首次再灌注心律失常后仍应重视重复再灌注心律失常的发生。

Objective Re-reperfusion arrhythmia during thrombolytic therapy for acute myocardial infarction was analyzed in this paper.Methods 30 patients with successful thrombolytic therapy for acute myocardial infarction was chosen at random as the revascularization group (RG),while 15 patients with failed thrombolytic therapy as non-revascularization group (NRG),15000000u urokinase was intravenously used within 30 minutes in each patient.Results Re-reperfusion arrhythmia occurred 50±10 minutes later after the occurrence of the first reperfusion arrhythmia in 8 of 15 patients with posterior wall acute myocardial infarction.Re-reperfusion arrhythmia was similar to reperfusion arrhythmia.Most of the re-reperfusion arrhythmia was first or second degree atrioventricular block(AVB),but with less severity and shorter time.AVB occurred in 5 of 9 patients with posterior wall infarction in NRG,and it lasted a longer time while had no relation to thrombolytic therapy.Conclusion Re-reperfusion arrhythmia during thrombolytic therapy for acute myocardial infarction should be noticed in case a reperfusion arrhythmia exists.