心肌梗死介入治疗术中心律及血压变化的意义

The change of blood pressure and heart rhythm during percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction

目的探讨急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入术(PCI)中再灌注心律失常及血压变化的特征及临床意义。方法选取2013年1月至2015年12月因急性STEMI行急诊PCI患者共196例,记录梗死相关动脉(IRA)开通后10min内心律失常、心率、血压变化情况以及心肌呈色分级(MBG)。结果 IRA开通后发生心律失常比例依次为:频发室性早搏和/或加速性室性自主心律(PVCs/AIVR,61.2%)、窦性心动过缓(SB,37.2%)、室性心动过速(VT,7.7%)、心室颤动(VF,4.0%)房室传导阻滞(AVB,2.0%)。其中SB发生比例在IRA右冠状动脉(RCA)组显著高于左前降支(LAD)组及左旋支(LCX)组(64.1%vs 5.3%vs 22.6%,p<0.001);冠脉开通后可发生一过性低血压,在RCA组较LAD或LCX组更多见(68.8%vs 42.6%vs 35.3%,p=0.002),出现一过性低血压组MBG较高。各梗塞组患者住院期间左心室射血分数(LVEF,54.6%vs 55.6%vs 54.5%,p=0.51)及病死率(2.6%vs 3.1%vs 0%,p=1)无差异。结论一过性SB及低血压是急诊PCI术后一种常见表现,在RCA梗塞组较多见;一过性低血压患者MBG较高,可能是心肌梗死后有效再灌注的表现。

Objective To explore the features and clinical significance of blood pressure(BP) and reperfusion arrhythmia(RA)during percutaneous coronary intervention(PCI) in patients with acute ST-segment elevation myocardial infarction(STEMI). Method The clinical information of 196 cases of STEMI who were undergoing emergency PCI from January 2013 to September 2015 were retrospectively analyzed. Recording the heart rate, the heart rhythm,the BP and myocardial blush grade(MBG) before and after canalization of infarction related artery(IRA), we try to find the regularities betweenthe BP, RA, MBG with IRA. Results The incidence of arrhythmia after PCI in turn was premature ventricular complexesand accelerated idioventricular rhythm(PVCs and AIVR, 61.2%), Sinus tachycardia(SB, 37.2%), Ventricular tachycardia(VT, 7.7%), ventricular fibrillation(VF4.0%) and atrioventricular block(AVB, 2.0%). Compare with the LAD group and LCX group, patients in RCA group had higher incidences of SB and transient hypotension. There are no significant difference in left ventricular function(LVEF) and in hospital mortality between transient hypotension group and normal BP group,but MBG is higher in the former. Conclusions Transient SB and hypotension are the feature of reperfusion after emergency PCI in STEMI patients especially in RCA infarction group, it is probably a sign of effective perfusion of myocardium after PCI.