胺碘酮治疗老年急性心肌梗死室性心律失常的疗效及短期预后的危险因素分析

Amiodarone in the Treatment of Ventricular Arrhythmia in Elderly Patients with Acute Myocardial Infarction

为了探讨胺碘酮治疗老年急性心肌梗死室性心律失常的疗效及短期预后的危险因素,选择2017年1月~2019年6月该院收治急性心肌梗死室性心律失常老年患者150例,按照患者治疗方式分为2组,每组75例;对照组采用普罗帕酮治疗,观察组接受胺碘酮治疗;连续治疗4 w,对比2组患者临床疗效、并发症发生情况,通过Logistic多因素分析预后不良患者高危因素。治疗4 w后,观察组患者临床总有效率明显高于对照组(90.67%vs 73.33%,P<0.05);患者总并发症发生率明显低于对照组(6.67%vs 18.67%,P<0.05);2组患者共出现死亡案例25例,经Logistic多因素分析后发现,年龄>70、梗死位置在前壁、Killip分级在Ⅲ~Ⅳ、心率>65次/min、糖化血红蛋白水平>6.3%均为老年急性心肌梗死室性心律失常患者治疗4 w内死亡的独立危险因素(P<0.05)。胺碘酮治疗急性心肌梗死合并室性心律失常更加安全有效,需提高对存在高危因素患者的关注,及时采取针对性有效措施进行治疗,以期改善患者预后,提高患者生存率。

To discuss the efficacy of amiodarone in the treatment of ventricular arrhythmia in elderly patients with acute myocardial infarction and the risk factors of short-term prognosis,from January 2017 to June 2019,150 elderly patients with ventricular arrhythmia due to acute myocardial infarction were enrolled in our hospital.Based on the treatment,they were divided into two groups,75 cases in each group.After admission,all patients underwent routine ECG examination and 24-hour ECG monitoring.The control group was treated with propafenone,100 mg/time,3 times/d.If the curative effect is not obvious after continuous medication for1 week,the dosage can be increased according to the patient’s condition.After the curative effect reaches the ideal effect,reduce the dosage to 150 mg/d.Patients in the observation group were given amiodarone treatment,usually 600 mg/d,for 8 ~ 10 days.According to the individual reaction,the minimum effective dose should be used for maintenance medication,100 ~ 400 mg a day.Due to the prolonged therapeutic effect of amiodarone,200 mg every other day or 100 mg a day can be given.After 4 weeks of continuous treatment,the clinical efficacy and complications of the two groups were compared,and the high risk factors of the patients with poor prognosis were analyzed by logistic multiple factors.After 4 weeks of treatment,the total clinical effective rate of the observation group was significantly higher than that of the control group(90.67% vs 73.33%,P<0.05);The total complication rate of the patients was significantly lower than that of the control group(6.67% vs 18.67%,P<0.05);25 cases of death occurred in the two groups.After logistic multiple factor analysis,it was found that age>70,infarct location in the anterior wall,Killip grading in Ⅲ-Ⅳ,heart rate>65 times/min,Hb A1 c>6.3% were independent risks factor of death in elderly patients with AMI(P<0.05).Amiodarone is more safe and effective in the treatment of acute myocardial infarction with ventricular arrhythmia.People need to pay more attention to the patients with high-risk factors and take effective measures to improve the prognosis and survival rate.