急性心肌梗死静脉溶栓与再灌注性心律失常

为进—步了解急性心肌梗死溶栓治疗中再灌注心律失常的主要形式及特点,观察尿激酶静脉溶栓治疗43例急性心肌梗死患者,其中27例临床判定再通,再通率62.79％,再灌注心律失常发生率以室性期前收缩(48.50％)和加速性心室自主节律(44.44％)为高,且后者与梗死组相比意义显著(P<0.01)。其特点为一过性,可自行终止,不转为恶性室性心动过速;且与胸痛缓解、ST段回降及酶峰前移的符合率明显高于未通组。认为加速性心室自主节律是溶栓后再灌注心律失常的特殊形式,可作为判定再通可靠的无创性指标之一。

Reperfusive arrhythmeas after intravenous thrormbolysis In a-cute myocardial infarction

In order to observe the forms and characteristics of reperfu-sion arrhythmias, forty three(43) patients with acute myocardial infarction (AMI) who received intravenous urokinase were studied. Results demonstrate that reperfusive rate after intravenous thrombolysis were 62. 79%. Ventricular prematur systole and accelerated idioventricular rhythm (AIVR) in reperfusive group were 48. 50%(P>0.05) and 44. 44%(P<0.01). Ocucr-rence of AIVR also associated with rapid relief of chest pain and resolution of ST segment elevation and simultaneous abrupt increase in serum creatine kinase-MB activity. Runs of AIVR were short, selfdeterminating and did not degenerate into ventricular tachycardia. So in our experience AIVR during the early hoursafter thrombolysis is a special form of reperfusive arrhythmia and a reliable sign of reperfusion.