急性ST段抬高型心肌梗死患者经皮冠状动脉介入术后再灌注心律失常的影响因素研究

Influencing Factors of Postoperative Reperfusion Arrhythmia in Acute ST-segment Elevation Myocardial Infarction Patients Underwent Percutaneous Coronary Intervention

目的分析急性ST段抬高型心肌梗死(ASTEMI)患者经皮冠状动脉介入术(PCI)后再灌注心律失常(RA)的影响因素。方法选取2015年1月—2017年1月于资阳市第一人民医院行PCI的ASTEMI患者328例,根据RA发生情况分为RA组165例与非RA组163例。比较两组患者临床特征、病变部位及预后,并记录RA类型,ASTEMI患者PCI后RA的影响因素分析采用多因素Logistic回归分析。结果两组患者性别、年龄、体质量、心力衰竭病史、糖尿病病史、高血压病史、心绞痛发生率、休克发生率、Killip分级、TIMI分级、发病至手术时间、梗死部位、冠状动脉闭塞部位比较,差异有统计学意义(P<0.05);两组患者体质指数、卒中病史、心肌梗死病史比较,差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,性别[OR=1.523,95%CI(1.195,1.943)]、年龄[OR=2.869,95%CI(1.523,5.404)]、体质量[OR=2.075,95%CI(1.353,3.182)]、心力衰竭病史[OR=10.827,95%CI(2.124,55.189)]、心绞痛[OR=2.945,95%CI(1.495,5.802)]、Killip分级[OR=7.917,95%CI(1.436,43.648)]、TIMI分级[OR=0.137,95%CI(0.032,0.585)]、梗死部位[OR=2.083,95%CI(1.364,3.182)]是ASTEMI患者PCI后RA的影响因素(P<0.05)。RA组患者中133例为缓慢型心律失常,32例为快速型心律失常。RA组患者预后良好率低于非RA组(P<0.05)。结论性别、年龄、体质量、心力衰竭、心绞痛、Killip分级、TIMI分级、梗死部位是ASTEMI患者PCI后RA的影响因素。

Objective To analyze the influencing factors of postoperative reperfusion arrhythmia(RA)in acute STsegment elevation myocardial infarction(ASTEMI)patients underwent percutaneous coronary intervention(PCI).Methods A total of 328 ASTEMI patients undergoing PCI were selected in the First People's Hospital of Ziyang,and they were divided RA group(n=165)and non-RA group(n=163).Clinical features,lesion location and prognosis were compared between the two groups,RA types were recorded,and influencing factors of postoperative RA in ASTEMI patients underwent PCI were analyzed by multivariate Logistic regression analysis.Results There were statistically significant differences of gender,age,body mass,medical history of heart failure,diabetes and hypertension,incidence of angina pectoris and shock,Killip grade,TIMI grade,duration between attack and operation,infarction location and coronary artery occlusion location between the two groups(P<0.05),while no statistically significant differences of BMI,medical history of stroke or myocardial infarction was found between the two groups(P>0.05).Multivariate Logistic regression analysis results showed that,gender〔OR=1.523,95%CI(1.195,1.943)〕,age〔OR=2.869,95%CI(1.523,5.404)〕,body mass〔OR=2.075,95%CI(1.353,3.182)〕,medical history of heart failure〔OR=10.827,95%CI(2.124,55.189)〕and angina pectoris〔OR=2.945,95%CI(1.495,5.802)〕,Killip grade〔OR=7.917,95%CI(1.436,43.648)〕,TIMI grade〔OR=0.137,95%CI(0.032,0.585)〕and infarction location〔OR=2.083,95%CI(1.364,3.182)〕were influencing factors of postoperative RA in ASTEMI patients underwent PCI(P<0.05).In RA group,133 cases were slow-type arrhythmia,the other 32 cases were tachycardiac arrhythmia.Proportion of patients with good prognosis in RA group was statistically significantly lower than that in non-RA group(P<0.05).Conclusion Gender,age,body mass,medical history of heart failure and angina pectoris,Killip grade,TIMI grade and infarction location are influencing factors of postoperative RA in ASTEMI patients underwent PCI.