急性心肌梗死行急诊介入治疗术中再灌注心律失常的临床分析

A study of reperfusion arrhythmias in patients with acute myocardial infarction during primary percutaneous coronary intervention

目的 分析急性ST段抬高型心肌梗死患者行急诊介入治疗（PCI）术中再灌注心律失常（RA）的临床特点.方法 回顾性分析2008年1月至2013年9月的马鞍山市人民医院心内科行急诊介入治疗（PCI）的175例急性ST段抬高型心肌梗死患者的临床资料,根据PCI术中是否出现RA分为RA组和NRA组,对比观察心肌酶及肌钙蛋白达峰值时间、抬高的ST段回落情况、住院时间,两组住院期间及术后1个月内心脏性死亡、休克、心力衰竭等不良事件发生率,以及比较术后第30天的两组心脏彩超结果.结果 RA组PCI时间窗显著早于NRA组,再灌注心律失常均得到有效控制.与NRA组比较,RA组有较高的ST段回落幅度,住院期间不良事件发生率较低;术后第30天时RA组具有较低的左室舒张期及收缩期内径及较高的左室射血分数（LVEF）值.结论 急性心肌梗死患者行直接PCI术中出现再灌注心律失常,只要及时处理,就会预后良好.

Objective To analyze the clinical features of patients with acute ST-elevation myocardial infarction treated with percutaneous coronary intervention （PCI） complicating to intraoperative reperfusion arrhythmias （RA）.Methods A total of 175 patients with acute ST-elevation myocardial infarction were treated with PCI performed from January 2008 to September 2013.According to the occurrence of RA following PCI,the patients were divided into RA group and non-RA （NRA） group.Comparison of myocardial enzymes,peak troponin,the elevated ST segment returning back,length of hospital stay,incidence of adverse events such as cardiac death,shock,heart failure during hospitalization and within a month of postoperative period was carried out between groups,and the findings from echocardiography on the 30th day after PCI were also compared between two groups.Results PCI time window in RA group was significantly earlier than that of NRA group,and reperfusion arrhythmia was effectively controlled.Compared with NRA group,RA group had greater extent of ST segment normalized,and tbe incidence of adverse events was lower.On the 30th day after PCI,RA group had shorter duration of left ventricular diastole,and reduced left ventricular cavity dimensions and higher ejection fraction （LVEF） value.Conclusions Reperfusion arrhythmias occur immediately after PCI in patients with acute myocardial infarction,but as long as the PCI carried out timely,the prognosis is good.