急性心肌梗死PCI治疗术中再灌注性心律失常的临床特点及对患者预后的影响

目的 探讨急性心肌梗死(AMI)进行经皮冠状动脉介入治疗(PCI)过程中再灌注性心律失常(RA)的临床特点及其对患者预后的影响.方法 选择2014年1月至2016年12月期间在盘锦市中心医院心内科治疗的240例急性心肌梗死行经皮冠状动脉介入治疗的患者作为研究对象,分析患者在PCI治疗术中再灌注性心律失常的发生率及其临床特点,并对患者预后情况进行探讨.结果 240例患者中150例出现了RA,RA的发生率为62.5％.高侧壁梗死、前壁梗死患者缓慢型心律失常发生率分别为10.53％、24.56％明显低于心下后壁梗死患者发生率44.86％(P＜0.05).而高侧壁梗死患者快速型心律失常的发生率为15.79％显著低于前壁梗死患者发生率36.84％ (P ＜0.05).前壁梗死患者缓慢型心律失常发生率显著高于快速型心律失常发生率,下后壁梗死患者缓慢型心律失常发生率显著低于快速型心律失常发生率(P＜0.05).再灌注时间＜6h者RA发生率为72.46％,而再灌注时间为6～12h的患者RA发生率为49.02％,即再灌注时间＜6h者RA发生率明显高于再灌注时间为6～12 h患者RA发生率(P＜0.05).单支血管病变患者、三支血管病变患者RA发生率分别为84.9％、70.7％显著高于两支血管病变患者52.1％(P＜0.05).住院期间和随访期间RA患者和无RA患者再梗死、死亡发生率比较无统计学意义(P＞0.05).结论 急性心肌梗死患者经PCI治疗术中再灌注性心律失常的发生率较高,不同心肌梗死部位、不同再灌注时间和不同冠状动脉病变血管支数再灌注性心律失常的发生率不同,及时发现RA并给予有效处理,可使相关患者的预后得到明显的改善.

Clinical characteristic and prognostic effect of reperfusion arrhythmia during percutaneous coronary intervention for acute myocardial infarction

Objective To investigate the clinical characteristic of reperfusion arrhythmia (RA) occurring in the process of percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) patients and its influence on prognosis. Methods A total of 240 patients, who were admitted in our hospital from January 2014 to December 2016 and received PCI for their acute myocardial infarction, were selected as the research objects. Analysis the clinical characteristic of reperfusion arrhythmia occurring in the process of PCI for the 240 acute myocardial infarction patients and its influence on patients'' prognosis was performed. Results The incidence of reperfusion arrhythmias during PCI treatment for acute myocardial infarction was 62.50%. The incidence of slow arrhythmia in patients with high lateral wall infarction and anterior wall infarction was 10.53% and 24.56%, respectively, which was significantly lower than that in patients with posterior wall infarction (44.86%) (P<0.05). The incidence of rapid arrhythmia in patients with high lateral wall infarction was 15.79%, which was significantly lower than that in patients with anterior wall infarction (36.84%) (P<0.05). In patients with anterior wall infarction, the incidence of slow arrhythmia was significantly higher than that of rapid arrhythmia; whereas in patients with inferior posterior wall infarction, the incidence of slow arrhythmia was significantly lower than that of rapid arrhythmia (P<0.05). In patients with reperfusion time less than 6 h the incidence of RA was 72.46%, respectively, significantly higher than that of 49.02% with reperfusion time 6-12 h (P<0.05). The incidence of RA in patients with single vessel disease and three vessel disease as 84.9% and 70.7%, respectively, which was significantly higher than that of 52.1% in patients with two vessel diseases (P<0.05). There was no significant difference in the incidence of infarction and death among RA patients and non RA patients during hospitalization and follow-up (P>0.05). Conclusion In patients with acute myocardial infarction treated by PCI, the incidence of intraoperative reperfusion arrhythmias is high. The incidence varies in myocardial infarction patients with different site of infarction, reperfusion time, or number of coronary artery involved. Timely detection and effective treatment of RA obviously improve the prognosis of the patients.