急性ST段抬高型心肌梗死经皮冠状动脉介入治疗术中再灌注心律失常的临床特点

目的观察急性sT段抬高型心肌梗死行经皮冠状动脉介入治疗（PCI）术中再灌注心律失常发生特点，提高救治成功率。方法对188例急性sT段抬高型心肌梗死患者在12小时内行急诊PCI，根据梗死相关动脉，分为前降支组、回旋支组及右冠状动脉组，观察3组再灌注心律失常发生情况，分析再灌注心律失常与梗死相关动脉的关系，了解冠脉再通时间对再灌注心律失常的影响。结果185例患者中185例成功植入支架。其中完全闭塞156例，次全闭塞或部分再通者32例，共发生再灌注心律失常75例，右冠状动脉组缓慢心律失常发生率高于前降支组和回旋支组，而快速心律失常发生率低于前降支组、回旋支组，但无统计学差异。开通时间越早，再灌注心律失常发生率越高，〈4小时组的快速心律失常发生率、缓慢心律失常发生率均大于4～8小时组、〉8小时组。结论直接PCI治疗开通梗死相关血管率高，是治疗急性心肌梗死的有效方法；随着血管的开通，可以发生再灌注心律失常，4小时内开通者发生再灌注心律失常高，右冠状动脉心肌梗死更容易发生缓慢性心律失常，只要及时处理，再灌注心律失常预后良好。

The clinical characteristics of reperfusion arrhythmias in patients with acute myocardial infarction during percutaneous coronary interventions

Objectives To investigate the characteristics of reperfusion arrhythmias （RA） in patients with acute myocardial infarction （ AMI ） during direct percutaneous coronary interventions （ PCI ）. Methods 188 consecutive patients with AMI were undergone procedures of PCI, according to infarction related arteries ,were divided into 3 groups（ LAD, LCX and RCA groups） ,the incidence of RA were inves- tigated in different coroDary infarction, and the impaction of the isehemia-reperfusion time on the incidence of RA were observed in patients with AMI during PCI. Results Among 188 patients with AMI, arrhythmi- as had occurred in 81 patients, bradycardia arrythmias were more occurred in patients with RCA infarction group than LAD, LCX infarction groups, but tachycardia arrhythmias were more occurred in patients with LAD infarction groups than RCA infarction groups. RA were more occurred in patients with the isehemia- reperfusion time before 4 hours than after 4 hours. Conclusions RA often occurred during PCI with AMI patients especilly with the ischemia-reperfusion time before 4 hours. The prognosis of RA is good if RA could be prevented and controlled with temporary cardiac, electronic diversion, etc.