心肌梗死急性期合并恶性室性心律失常患者院内死亡危险因素资料分析

Risk factors of death in patients with acute mvocardial infarction in the acute stage of myocardial infarction

目的探讨心肌梗死急性期合并恶性室性心律失常患者的院内死亡危险因素。方法选取我院2012年6月至2014年12月期间收治的172例心肌梗死急性期合并恶性室性心律失常患者作为研究对象,按照患者的最后治疗结果分为两组,存活出院的患者设为A组,院内死亡的患者设为B组,观察两组基线对比情况。结果A组患者比B组患者,男性占比高,年龄更小,心功能状况较好,合并糖尿病和心绞痛病的患者占比更少,急性心肌梗死发作距离恶性室性心律失常间隔时间短。肌酐平均水平和血清钾平均水平更低,组间差异具有统计学意义(P<0.05)。在体表心电图中J波的检出率A组患者比B组患者更低,差异具有统计学意义(P<0.05)。通过Logistic回归分析显示,NYHA高于I级(危险比:5.66,95%CI 1.45~22.02,P<0.05),心电图存在J波(危险比:4.36,95%CI1.84~10.46,P<0.05),急性心肌梗死发作距恶性室性心律失常间隔时间超过24h(1~13d危险比:3.01,95%CI0.28~6.94,P<0.05;14~30d危险比:3.40,95%CI 1.41~8.30,P<0.05),血清肌酐水平高于正常(危险比:5.25,95%CI2.11~13.15,P<0.05)。结论在心肌梗死急性期合并恶性室性心律失常患者的临床治疗中,患者的心功能级别、合并症、心电图J波的存在,以及急性心肌梗死发作距恶性室性心律失常间隔时间是否超过24h、血清肌酐水平高于正常参考值等可能与患者院内死亡相关。

Objective To investigate the risk factors of death in patients with acute myocardial infarction complicated with malignant ventricular arrhythrnia.Methods 172 patients with acute myocardial infarction in our hospital from June 2012 to December 2014 were selected as the study object.The patients were divided into two groups according to the final treatment results.The patients were divided into group A (survival group)and group B (death group).Results The survival of patients in group A were discharged from hospital with higher proportion of male,younger age and heart function in better condition;there were less complications with diabetes and heart disease with angina pectoris;the interval time of malignant ventricular arrhythmia from acute myocardial infarction was in a shorter interval of time and the average levels of serum potassium and creatinine average level were lower.P was less than 0.05.There were statistical significance among the deferences.The electrocardiogram J wave detection rate in group A were lower than group B and the difference was statistically significant(P<0.05).The Logistic regression analysis showed that NYHA was higher than that of grade I (HR= 5.66;95%CI 1.45-22.02;P<0.05),electrocardiogram J wave (HR=4.36;95%CI 1.84-10.46;P<0.05),the onset of acute myocardial infarction from malignant ventricular arrhythmia interval more than 24h(1-13day HR= 3.01;95%CI 0.28-6.94;P<0.05.14-30day HR=3.40;95%CI 1.41-8.30;P<0.05)serum creatinine level was higher than normal (HR=5.25;95%CI 2.11-13.15;P<0.05).Conclusion In the clinical treatment of patients with acute myocardial infarction complicated with malignant ventricular arrhythmia,patients with heart function level,complications,ECG J wave,as well as acute myocardial infarction in patients with acute myocardial infarction,the interval time is more than 24h,serum creatinine level is higher than normal may be associated with the patient's survival and hospital death.