急性心肌梗死（AMI）患者合并恶性室性心律失常的危险因素分析

Analysis of risk factors in patients with acute myocardial infarction complicated with malignant ventricular arrhythmia

目的探讨急性心肌梗死患者合并恶性室性心律失常的危险因素,为临床防治工作提供依据。方法将我院收治的200例急性ST段抬高型心肌梗死患者作为本次研究对象,所有对象均行经皮冠状动脉介入术治疗;根据术后48 h患者是否发生恶性室性心律失常将其分为对照组(未合并恶性室性心律失常,174例)与观察组(合并恶性室性心律失常,26例)。比较两组间相关资料,并筛查出恶性室性心律失常发生影响单因素,然后对单因素行Logistic回归分析,分析恶性室性心律失常发生高危因素。结果观察组患者白细胞计数、中性粒细胞计数、入院时血糖水平明显高于对照组(P<0.05);观察组糖尿病和心功能Ⅳ级比例明显高于对照组,入院时血钾水平明显低于对照组(P<0.05)。经Logistic回归分析发现,患者入院时白细胞计数和中性粒细胞计数升高、血钾水平下降、血糖水平升高及心功能Ⅳ级为急性ST段抬高型心肌梗死并发恶性室性心律失常的高危因素(P<0.05)。结论急性ST段抬高型心肌梗死并发恶性室性心律失常的影响因素较多,临床需对高危型患者加以关注和干预,以避免发生恶性室性心律失常。

Objective To investigate the risk factors in patients with acute myocardial infarction complicated with malignant ventricular arrhythmia, and to provide a basis for clinical prevention and treatment. Methods 200 patients with acute ST-segment elevation myocardial infarction admitted to the hospital were enrolled in this study. All subjects underwent percutaneous coronary intervention. According to whether the patient had malignant ventricular arrhythmia 48 hours after surgery, they were divided into the control group(n=174, without malignant ventricular arrhythmia) and the observation group(n=26, with malignant ventricular arrhythmia). The data were compared between the two groups. The single factor of malignant ventricular arrhythmia was screened out. Then the Logistic regression analysis of single factor was used to analyze the risk factors of malignant ventricular arrhythmia. Results The white blood cell count, neutrophil count and blood glucose level at admission in the observation group were significantly higher than those in the control group(P<0.05). The proportion of diabetes and heart function Ⅳ in the observation group was significantly higher than that in the control group, and the blood potassium level was significantly lower than that in the control group(P<0.05).Logistic regression analysis showed that increased white blood cell count and neutrophil count, decreased serum potassium levels, elevated blood glucose levels, and grade Ⅳ cardiac function at admission were high risk factors in pa tients with acute ST-segment elevation myocardial infarction complicated with malignant ventricular arrhythmias( P<0.05). Conclusion There are many influencing factors of acute ST-segment elevation myocardial infarction complicated with malignant ventricular arrhythmia. It is necessary to pay attention to and intervene high-risk patients to avoid malignant ventricular arrhythmia.