ST段抬高型急性心肌梗死诱发恶性室性心律失常的危险因素

Analysis about risk factors of malignant ventricular arrhythmias of ST-elevation myocardial infarction

目的探讨ST段抬高型急性心肌梗死诱发恶性室性心律失常(MVA)的危险因素。方法回顾分析就诊于我院并确诊断为ST段抬高型急性心肌梗死患者158例,依据患者在直接PCI手术48小时后是否发生MVA分成研究组(发生MVA,32例)及对照组(未发生MVA,126例),统计并比较两组患者的基础临床资料指标、心电图指标、实验室检查指标、冠状动脉造影指标等。结果研究组糖尿病患者比例、血糖水平、肌酐水平、白细胞水平、中性粒细胞水平以及心功能KlillipⅣ级比例均明显高于对照组(P<0.05),血钾浓度明显低于对照组(P<0.05)。ST段抬高型急性心肌梗死诱发MVA的危险因素包括心功能KlillipⅣ级、白细胞计数≥11.040×109/L、中性粒细胞计数≥8.155×109/L、血糖≥9.58mmol/L、血钾≤3.13mmol/L、肌酐≥96.93μmol/L(P<0.01)。结论针对合并有上述危险因素的ST段抬高型急性心肌梗死患者应加强临床干预措施,降低MVA发生率,改善患者预后。

Objective To analyze the risk factors of malignant ventricular arrhythmias（MVA）of ST-elevation myocardial infarction.Methods Retrospective analysis was made in 158 cases of patients in our hospital who had clear and definite diagnosis for ST-elevation myocardial infarction.The patients were divided into study group（MVA incidence,32cases）and control group（no MVA incidence,126cases）according to the incidence of MVA 48 hours after primary PCI.The clinical indicators such as basic clinical indicators,ECG,laboratory test,coronary angiography of two groups were counted and compared.Results The proportion of patients with diabetes,the level of blood glucose,level of serum creatinine,level of leukocyte,level of neutrophil cell and proportion of heart function Klillip gradeⅣ of patients in study group were significantly higher than those in control group（P 0.05）,while the serum potassium concentration was significantly lower than that of control group（P 0.05）.The risk factors of MVA of ST-elevation myocardial infarction included heart function Klillip gradeⅣ,leukocyte count was greater than or equal to11.040×109/L,neutrophils count was greater than or equal to 8.155×109/L,the level of blood glucose was more than or equal to 9.58mmol/L,serum potassium was less than or equal to 3.13mmol/L,creatinine was more than or equal to 96.93 μmol/L（P 0.01）.Conclusion The clinical intervention measures of ST-elevation myocardial infarction in view of the above risk factors should be strengthened,the incidence of MVA will be reduced,the prognosis of patients will be improved.