再灌注治疗对急性心肌梗死合并Ⅲ度房室传导阻滞患者预后的影响

目的对比研究不同再灌注治疗对急性心肌梗死（AMI）合并Ⅲ度房室传导阻滞（Ⅲ。AVB）患者预后的影响。方法2007年1月至2012年1月住院的AMI合并111。AVB患者69例，分为对照组、溶栓组和介入组，比较三组患者心源性休克、恶性心律失常、心衰等发生率和总死亡率。于再灌注治疗后6个月对存活者行心脏超声检查，测定左室射血分数（LVEF）和左室舒张末期内径（LVD）。结果①介人组再灌注治疗后心源性休克、恶性心律失常、心衰等发生率和总死亡率均明显低于溶栓组及对照组，溶栓组亦明显低于对照组，差异均有统计学意义（P〈0．05）。②6个月后三组存活者行心脏超声心动图检查，介入组LVEF明显高于溶栓组及对照组（P〈0．05），LVD明显低于溶栓组及对照组（P〈0．05）。结论AMI合并Ⅲ。AVB预后差，住院期问心源性休克、恶性心律失常、心衰等发生率和死亡率高。AMI后行急诊再灌注能改善左心功能和预后，行急诊冠脉介入治疗较静脉溶栓治疗效果更为突出。

Effect of reperfusion therapy for patients prognosis with complete atrioventricular block complicating acute myocardial infarction

Objective This study the different effect of reperfusion therapy for patients prognosis with com- plete atrioventricular block （CAVB） complicating acute myocardial infarction （AMI） comparatively. Methods 69 patients with CAVB complicating AMI from 2007 January to 2012 January were divided into control group, reperfu- sion group and intervention group, and compared the cardiogenic shock, arrhythmia, heart failure incidence and total mortality. The left ventricular ejection fraction （LVEF） and left ventricular end diastolic diameter （LVD） were measured by echocardiograma after 6 months for survivors of them. Results （ 1 ）The intervention group were signif- icantly lower than those of the thrombolysis group and control group in cardiogenic shock, arrhythmia, heart failure incidence and total mortality after reperfusion therapy （P〈0.05）,and the thrombolysis group was significantly lower than that of the control group too （P〈0.05）. （2）The survivors of intervention group were significantly higher than that of the survivors of thrombolysis group and control group in the LVEF after 6 months（P〈O.05）, and were signif- icantly lower in LVD（P〈0.05 ）. Conclusion Patients with CAVB complicating AMI have a significant poor progno- sis for the higher cardiogenic shock,arrhythmia,heart failure incidence and total mortality.Coronary reperfusion therapy may contribute to improve the left ventricular function and prognosis, and the effect of primary percutaneous coronary intervention.is more outstanding than that of intravenous thrombolytic therapy.