临时起搏器在急性下壁心肌梗死急诊介入术中应用的临床意义

Clinical Significance of Temporary Pacemakers in Emergency Intervention for Acute Inferior Myocardial Infarction

目的 :探讨临时起搏器在急性下壁心肌梗死患者急诊介入术中应用的临床意义。方法 :选择2015年8月—2017年6月我科收治的60例急性下壁心肌梗死患者为研究对象,依据急性心肌梗死急诊介入治疗指南拟行冠状动脉介入术,按随机数字表法分为A、B两组,各30例。两组术前均给予负荷量抗血小板聚集药物,A组术前植入右心室临时起搏器;B组应用阿托品(1～3 mg)及咳嗽运动增加心室率,比较两组术中心血管事件发生情况。结果 :两组缓慢性心律失常、无复流现象、急性心血管事件发生率比较,差异无统计学意义(P> 0.05);A组再灌注后恶性快速心律失常及血压下降发生率高于B组,差异有统计学意义(P <0.05)。结论 :临时起搏器在急性下壁心肌梗死患者急诊介入术中作用有限,临床意义有待商榷。

Objective: To investigate the clinical significance of temporary pacemakers in emergency intervention for patients with acute inferior myocardial infarction. Methods: 60 patients with acute inferior myocardial infarction admitted to our department from August 2015 to June 2017 were selected as subjects investigated and scheduled for coronary intervention acccording to the Guidelines for Emergency Interventional Therapy for acute myocardial infarction. All patients were divided into two groups A and B, 30 cases in each group. The patients in the two groups were given anti-platelet aggregation drugs before operation. The patients in the group A were implanted with right ventricular temporary pacemaker before operation, and the patients in the group B were treated with atropine(1~3 mg) and did cough exercise to increase ventricular rate. The occurrence of cardiovascular events during operation was compared between the two groups. Results: There was no statistically significant difference in the incidences of slow arrhythmia, no-reflow phenomenon and acute cardiovascular events between the two groups(P>0.05). The incidences of malignant tachyarrhythmia and blood pressure drop occurred after reperfusion in group A were higher than those in the group B, with statistically significant difference(P<0.05). Conclusion: Temporary pacemakers have limited role in emergency intervention for patients with acute inferior myocardial infarction, and their clinical significance remains to be discussed.