急性心肌梗死直接冠脉介入治疗术中再灌注心律失常临床分析

目的　对直接冠脉介入治疗术 (PCI)治疗急性心肌梗死 (AMI)中出现的再灌注性心律失常进行分析 ,探讨其治疗及预防 ,以提高手术成功率。方法　 176例AMI患者行直接PCI,其中 5 6例发生再灌注性心律失常 ,观察再灌注性心律失常的类型 ;再灌注性心律失常与发病后至冠脉再通时间的关系 ;再灌注性心律失常与梗死范围大小的关系 ;再灌注性心律失常与冠脉病变支数的关系 ;再灌注性心律失常与梗死部位的关系。结果　AMI后 6h内行直接PCI术者再灌注性心律失常发生率明显高于AMI后 6～ 2 4h行直接PCI术者 (P <0 .0 1) ;再灌注性心律失常发生率多支血管病变者高于单支血管病变者 (P <0 .0 5 ) ;再灌注后出现缓慢性心律失常 :下壁心肌梗死者明显高于前壁心肌梗死者 (P <0 .0 1) ;再灌注性心律失常与梗死范围大小无明显关系 (P >0 .0 5 )。结论　AMI直接PCI后再灌注心律失常是一种较常见的并发症 ,正确的预防和处理对提高患者的生存率、改善预后具有重要的意义

Clinical analysis of reperfusion arrhythmias in acute myocardial infarction treated by direct PCI

Objective To analyse reperfusion arrhythmias in AMI patients treated by direct PCI. To investigate prevention and treatments so as to elevate operation achievement ratio.Methods One hundred and seventy six AMI patients underwent direct PCI; of the 176 patients, 56 presented reperfusion arrhythmias. Observations were made in the context of the different arrhythmias, relation between the time onset of the arrhythmias after reperfusion, relation of infarct size number of the involved vessels and the infarct size to the arrhythmias. Results PCI performed with six hours after AMI showed much higher incidence of arrhythmias than PCI performed six to twenty four hours after AMI (P< 0.01). Multi-vessel disease AMI patients yielded a higher incidence of reperfusion arrhythmias than single-vessel disease AMI patients (P <0.05). Brady-arrhythmias appeared more in inferior infarction patients (P< 0.01). No apparent connection between infarct size and reperfusion arrhythmias was noted (P >0.05).Conclusions Reperfusion arrhythmias were commonly seen in AMI patients treated by direct PCI. Early prevention and detection with appropriate treatment is the key to elevate survival rate leading to a better prognosis.