老年急性心肌梗死后发生严重心律失常的临床影响因素分析

Clinical correlation factors for severe arrhythmia in the elderly with acute myocardial infarction

目的分析老年急性心肌梗死后发生严重心律失常的临床影响因素。方法选取2012年7月至2014年7月我院收治的急性心肌梗死老年患者196例,根据患者心肌梗死后是否并发严重心律失常分为心律失常组104例和对照组92例。收集患者一般信息和心肌梗死病理等,Logistic回归分析老年急性心肌梗死后发生严重心率失常的影响因素。结果与对照组比较,心律失常组患者的病程较短(P<0.05),白细胞计数和中性粒细胞计数水平较高(P<0.05),心率变异性(HRV)的时域指数和频域指数水平降低(P<0.05),动态心电图QT间期变异度水平降低(P<0.05),前壁心肌梗死患者较多(P<0.05),且患者多为左冠状动脉闭塞(P<0.05)。经Logistic回归分析显示,病程短、HRV时域指数和频域指数水平降低、QTV水平降低、前壁梗死和左冠状动脉闭塞是老年急性心肌梗死后发生严重心率失常的相关危险因素。结论病程短、HRV时域指数和频域指数水平降低、QTV水平降低、前壁梗死和左冠状动脉闭塞患者是临床老年急性心肌梗死患者发生严重心律失常的高危群体,临床救治中应给与一定的预防治疗措施。

Objective To analyze the clinical correlation factors for severe arrhythmia in the elderly with acute myocardial infarction. Methods One hundred and ninety-six elderly patients with acute myocardial infarction were surveyed from July 2012 to July 2014 in our hospital. They were divided into the severe arrhythmia group（104cases） and the control group（92 cases） according to whether they were accompanied with severe arrhythmia after acute myocardial infarction. The essential information of the elderly and pathology information of acute myocardial infarction were collected. The correlation factors for severe arrhythmia in the elderly with acute myocardial infarction were analyzed by logistic method. Results Compared with the control group, patients in the severe arrhythmia group had a shorter duration of acute myocardial infarction（P〈0.05）, higher levels of white blood cell count and neutrophil count（P〈0.05）, decreased levels of heart rate variability（HRV） index and QT interval variability（QTV）（P〈0.05）,with more patients of anterior wall infarction（P〈0.05） and left coronary artery occlusion（P〈0.05）. Logistic regression analysis showed that shorter duration of acute myocardial infarction, decreased level of HRV, decreased level of QTV,anterior wall infarction and left coronary artery occlusion were the correlation factors for severe arrhythmia in the elderly with acute myocardial infarction. Conclusion The patients who had shorter duration of acute myocardial infarction, decreased level of HRV and QTV, anterior wall infarction and left coronary artery occlusion were the high-risk patients for severe arrhythmia after acute myocardial infarction. Effective prevention measures should be applied in clinical treatment.