急性ST段抬高型心肌梗死心脏骤停患者的临床特点和复苏后行急诊PCI的安全性

Clinical characteristics in patients with sudden cardiac arrest of acute ST-segment elevation myocardial infarction and safety of emergency PCI after cardiopulmonary resuscitation

目的分析急性ST段抬高型心肌梗死(STEMI)心脏骤停患者的临床特点及复苏成功患者行急诊冠状动脉介入治疗(PCI)的安全性。方法回顾性收集2010年1月~2013年3月于宝鸡市中医医院就诊的240例STEMI患者临床资料,其中男性197例,女性43例,根据其PCI前是否发生心脏骤停及复苏是否成功分为未行心肺复苏组(195例)、复苏成功组(22例)和猝死组(23例)。复苏成功组和未行心肺复苏组患者均接受急诊PCI。收集入选患者病史、人口学资料、临床检查结果、标准12导联心电图、冠状动脉造影检查结果以及PCI术中的急救情况。记录住院期间不良事件,包括心力衰竭、室颤、心源性休克以及死亡。所有患者随访6个月,记录再住院、心力衰竭及死亡情况。结果与未行心肺复苏组比较,复苏成功组及猝死组年龄、合并脑梗死比例以及QT离散度增加,差异有统计学意义(P均<0.05)。与未行心肺复苏组比较,复苏成功组合并高血脂比例增加,差异有统计学意义(P<0.05)。与未行心肺复苏组相比,复苏成功组除颤、使用升压药物以及应用抽吸导管比例明显增加,差异具有统计学意义(P均<0.05)。两组住院期间心力衰竭、室颤、心源性休克的发生率比较,差异均无统计学意义(P均>0.05)。出院后随访6个月,未行心肺复苏组再住院、死亡比例与复苏成功组比较,差异均无统计学意义(P均>0.05)。复苏成功组心力衰竭的发生率高于未行心肺复苏组,9.1%vs.1.0%,差异有统计学意义(P<0.05)。结论 STEMI患者发生心脏骤停与年龄、高血脂、脑梗死、QT离散度关系密切,STEMI心脏骤停复苏成功患者行急诊PCI安全性良好。

Objective To analyze the clinical characteristics in patients with sudden cardiac arrest of acute STsegmentelevation myocardial infarction(STEMI)and safety of emergency percutaneous coronary intervention(PCI)aftersuccess cardiopulmonary resuscitation.Methods The clinical data was retrospectively collected from STEMI patients(n=240,male197and female43)treated in the Hospital of Traditional Chinese Medicine in Baoji City from Jan.2010toMar.2013.All patients were divided,according to whether cardiac arrest or not and whether success cardiopulmonaryresuscitation or not,into non-resuscitation group(n=195),success resuscitation group(n=22)and sudden death group(n=23).The success resuscitation group and non-resuscitation group were given emergency PCI.The data of medicalhistory,demographics,clinical examination outcomes,standard12-lead electrocardiogram(ECG),outcomes of coronaryangiography(CAG)and rescue status during PCI were collected.The adverse events were recorded including heartfailure,ventricular fibrillation(VF),cardiogenic shock(CGS)and death during hospitalization.All patients were followedup for6m for recording the status of re-hospitalization,heart failure and death.Results The age,percentage of patientscomplicated by cerebral infarction and QT interval dispersion(QTd)increased in success resuscitation group andsudden death group compared with non-resuscitation group(all P<0.05).The percentage of patients complicated byhyperlipidemia increased in success resuscitation group compared with non-resuscitation group(P<0.05).The percentageof patients with defibrillation,vasopressors and suction catheter increased in success resuscitation group compared withnon-resuscitation group(all P<0.05).The comparison in the incidence of heart failure,VF and CGS during hospitalizationhad no statistical significance between success resuscitation group and non-resuscitation group(all P>0.05),andcomparison in percentages of re-hospitalization and death had no statistical significance between2groups(all P>0.05).The incidence of heart failure was higher in success resuscitation group than that in non-resuscitation group(9.1%vs.1.0%,P<0.05).Conclusion Sudden cardiac arrest is closely related to age,hyperlipidemia,cerebral infarction and QTdin STEMI patients,and PCI is safe in those with success cardiopulmonary resuscitation.