急性心肌梗塞溶栓后再灌注心律失常的临床研究

目的探讨急性心肌梗塞(AMI)静脉溶栓后再灌注心律失常(RA)的发生情况及其临床意义。方法136例AMI患者经尿激酶或链激酶静脉溶栓治疗,其中76例符合冠脉再通标准,为再灌注组,60例未达到冠脉再通标准,为未灌注组,比较两组心律失常的发生率、发生频率、类型、抗心律失常药物的使用率及心脏事件的发生率。结果两组心律失常发生率差异无显著性(P>0.05),再灌注组一过性的加速性室性自主心律、缓慢性心律失常明显高于未灌注组(P<0.05或0.01),再灌注组心律失常的发生率在第2~4h明显高于未灌注组,从第8h开始明显低于未灌注组(P<0.01或0.05),再灌注组抗心律失常药物的使用率、心脏事件的发生率明显低于未灌注组(P均<0.01)。结论再灌注组和未灌注组在心律失常的发生类型、频率及抗心律失常药物的使用方面差异有显著性,冠脉再灌注可减少AMI心脏性事件,降低病死率。

The significance of thrombolysis - induced reperfusion arrhythmias in acute myocardial infarction

ObjectiveTo outline the occurrences and clinical significance of thrombolysis-induced reperfusion arrhythmias(RA) in acute myocardial infarction(AMI).Methods 136 patients with AMI were enrolled in this review and received infusional urokinase and streptokinase,respectively.Of the 76 cases who had achieved the clinical standard of reperfusion were assigned into the reperfusion group,and of the 60 cases who had not achieved that standard were assigned into the no-reperfusion group.A comparison of the incidences of arrhythmias and frequency,the type of arrhythmia,the anti-arrhythmia agent usage and the incidence of cardiac event between reperfusion group and no-reperfusion group had been performed.Results There was no statistical significance of difference in the incidence of arrhythmia between the reperfusion group and no-reperfusion group(P>0.05).In the reperfusion group,the incidences of transient accelerated idioventricular rhythm and bradyarrhythmia were higher than the no-reperfusion group,there were statistical significances of difference(P<0.05 or 0.01).The incidence of arrhythmia in the reperfusion group was significantly higher than the no-reperfusion group at the range of 2～4 hours,but after 8 hours of reperfusion,the incidence of arrhythmia was significantly lower than the no-reperfusion group(P<0.01 or 0.05).In the reperfusion group,the anti-arrhythmia usage and the incidence of cardiac events were lower than the no-reperfusion group(both P<0.01). Conclusion The reperfusion group differs greatly from no-reperfusion in type of arrhythmia,occurring frequency of arrhythmia and usage of the anti-arrhythmia agent.The myocardial reperfusion can reduce the cardiac events and decrease the mortality.