静脉溶栓治疗急性心肌梗死再通后心律失常的临床特点

目的观察分析静脉溶栓治疗急性心肌梗死再通后心律失常发生特点。方法选取静脉溶栓治疗的急性心肌梗死患者50例,溶栓治疗前后均严格进行心电监测及病情观察,观察本组患者血管再通及再灌注心律失常的发生情况。结果 50例患者均无明显出血倾向,其中40例(80.00%)判定为血管再通,42例(84.00%)在溶栓治疗开始后2 h内发生心律失常,其中23例(54.76%)为加速性室性自主心律,9例(21.43%)发生室性早搏,5例(11.90%)发生房性早搏,窦性停搏或房室传导阻滞均发生在下壁心肌梗死,其中2例(66.67%)为血管再通患者,1例(33.33%)为血管未通患者。42例发生再灌注心律失常患者中,38例自行缓解,3例经静脉推注利多卡因后复律,1例血管未通发生室颤者抢救无效死亡。结论早期进行静脉溶栓治疗可提高急性心肌梗死患者冠脉再通率,但易再灌注心律失常,因此,在溶栓治疗期间应加强心电监测,必要时应积极处理,以提高溶栓治疗成功率。

Clinical characteristics of arrhythmia after intravenous thrombolytic therapy with recanalization

Objective To observe and analyze the characteristics of arrhythmia after intravenous thrombolytic therapy with recanalization.Methods Fifty acute myocardial infarction patients who received intravenous thrombolytic therapy were included in the study.Before and after thrombolytic therapy,ECG monitoring was strictly conducted.The incidence of recanalization and reperfusion arrhythmias was observed.Results Fifty patients had no obvious bleeding tendency,of which 40 cases(80.00%) were confirmed with recanalization.Forty-two cases(84.00%) had cardiac arrhythmia within 2 hours after the thrombolytic therapy,of which 23 cases(54.76%) had accelerative idioventricular rhythm,9 cases(21.43%) premature ventricular contractions, and 5 cases(11.90%) atrial premature beats,sinus arrest or atrioventricular block in the next wall myocardial infarction.Among the 42 cases,two cases(66.67%) had vascular recanalization,and one case(33.33%) had obstructed vessel.Among 42 cases of reperfusion arrhythmia,38 cases had spontaneous remission,and three cases had sinus rhythm when intravenous injection of lidocaine was administered.One case had obstructed blood vessel and died due to ventricular fibrillation.Conclusion Early intravenous thrombolytic therapy can improve the infarct-related artery recanalization rate of patients with acute myocardial infarction,but it can easily lead to reperfusion arrhythmias during thrombolytic therapy.ECG monitoring should be strengthened actively,where necessary,in order to improve success rate of thrombolytic therapy.