老年急性心肌梗死患者并发严重心律失常及危险因素分析

Risk factors for elderly patients with acute myocardial infarction complicated with severe arrhythmia

目的探讨老年急性心肌梗死患者并发严重心律失常状况及危险因素。方法选取2014年1月—2016年5月解放军第451医院收治的128例老年急性心肌梗死患者作为研究对象,根据其在心肌梗死后是否并发心律失常分为A组(发生严重心律失常)98例和B组(未发生心律失常)30例,比较2组患者性别、年龄、既往病史等一般临床资料及入院后各种实验室及心电图检查结果,并通过非条件单因素或多因素Logistic回归模型分析并发严重心律失常的相关危险因素。结果 2组患者在血常规、心肌酶谱、心率变异性分析、QTV及梗死部位中的前壁梗死和冠状动脉闭塞的比较差异具有统计学意义(P<0.05);病程短、前壁心肌梗死、心率变异性分析中各指标降低及左冠状动脉闭塞是引发急性心肌梗死患者并发严重心律失常的独立危险因素存在(P<0.05)。结论老年急性心肌梗死患者其严重心律失常发病率高,且病程短、前壁心肌梗死、CK、CK-MB水平升高、心率变异性分析中各指标降低及左冠状动脉闭塞是引发急性心肌梗死患者并发严重心律失常的独立危险因素存在。

Objective To investigate the status and risk factors of severe arrhythmia in elderly patients with acute myocardial infarction （AMI）.Methods One hundred and twenty-eight elderly patients with acute myocardial infarction admitted to our hospital between January 2014 and May 2016 were selected as subjects, who were divided into group A （98 cases of severe arrhythmia） and group B （30 cases without arrhythmia） according to whether there was arrhythmia after myocardial infarction. Clinical data was compared between two groups with regard to gender, age, medical history and a variety of laboratory and ECG results after admission. Unconditional univariate or multivariate logistic regression models were used to analyze the related risk factors for severe arrhythmias.Results Significant differences were detected between the two groups in blood routine, myocardial enzymes, heart rate variability analysis, QTV and infarct anterior wall infarction and coronary artery occlusion （P〈0.05）. Short durations, anterior myocardial infarction, a decrease in indexes of heart rate variability analysis and left coronary artery occlusion were independent risk factors for acute myocardial infarction complicated with severe arrhythmia （P〈0.05）.Conclusion The incidence of severe arrhythmia in elderly patients with acute myocardial infarction is high. A short duration of disease, anterior wall myocardial infarction, increases in CK, CK-MB levels,heart rate variability analysis and left coronary artery occlusion are independent risk factors for acute myocardial infarction patients with severe arrhythmia.