急性心肌梗死急诊经皮冠状动脉腔内血管成形术中心律失常特点及处理

Characteristics and Management of Arrhythmia During Emergency PTCA for Acute Myocardial Infarction

目的分析急性心肌梗死患者在急诊行经皮冠状动脉腔内血管成形术(PTCA)的过程中发生心律失常的临床特点及有效处理。方法筛选佳木斯市中心医院心内二科在2015年6月—2017年6月期间收治的急性心肌梗死急诊行PTCA术的患者300例,对其完整的病例资料进行回顾性分析。主要分析研究急性心肌梗死患者在行急诊PTCA时心律失常的发生过程和需要采取的处理方法,最后得到其心律失常的特点及应对方法,从而降低急诊PTCA术的病死率。结果统计发现在300例急性心肌梗死急诊PTCA术中有245例患者发生心律失常,占81.7%;其中再灌注心律失常患者188例,占心律失常患者的76.7%,非再灌注心律失常患者57例,占心律失常患者的23.3%,显著低于再灌注心律失常患者。PTCA术中对心律失常的处理方法依据不同情况而采取不同方法,其中对再灌注心律失常的153例频发室早患者行静推利多卡因,对22例室速患者行静推利多卡因,对8例室颤患者进行电复律,对8例心动过缓患者行临时起搏。结论在急性心肌梗死急诊PTCA术中患者发生心律失常的几率很大,其中多数为再灌注心律失常,严重威胁生命安全,临床上应在手术中采用有效处理方法降低病死率,提高手术成功率。

Objective To analyze the clinical characteristics and effective management of arrhythmias in patients with acute myocardial infarction undergoing emergency percutaneous coronary angioplasty(PTCA).Methods A total of 300 acute myocardial infarction patients who underwent emergency PTCA in the department from June,2015 to June,2017 were screened,and their com plete case data were retrospectively analyzed.The paper mainly analyzed and studied the occurrence process of arrhythmia in pa tients with acute myocardial infarction during emergency PTCA and the treatment methods needed to be adopted,and finally the characteristics and countermeasures of arrhythmia in patients with acute myocardial infarction,so as to reduce the mortality of emergency PTCA.Results 245 patients(81.7%)with arrhythmia occurred in the emergency PTCA of 300 patients with acute myo cardial infarction.Among them,188 patients with reperfusion arrhythmia,accounting for 76.7%of arrhythmia patients;and 57 pa tients without reperfusion arrhythmia,accounting for 23.3%of arrhythmia patients,which were significantly lower than those with reperfusion arrhythmia.The treatment of arrhythmia in PTCA depended on different conditions,among which 153 cases of frequent ventricular arrhythmias with reperfusion were treated with intravenous lidocaine,22 cases of ventricular tachycardia were treated with intravenous lidocaine,8 cases of ventricular fibrillation were treated with electric cardioversion,and 8 cases of bradycardia were treated with temporary pacing.Conclusion Patients with acute myocardial infarction during emergency PTCA have a high inci dence of arrhythmias,most of which are reperfusion arrhythmias,which seriously threatens the safety of life.Clinically,effective treatment should be adopted in the operation to reduce the mortality,and improve the success rate of the operation.