急性心肌梗死冠状动脉内血栓溶解治疗与再灌注性心律失常

２２例急性心肌梗死患者接受经皮冠状动脉内血栓溶解治疗，经即刻冠状动脉造影证实１４例冠状动脉再通。９例（６４．３％）发生再灌注性心律失常（ＲＡ）。１４例中７例（５０．０％）为室性ＲＡ，３例（２１．４％）发生加速性室性自主节律，后者为提示再灌注的特异性较高的指标。一过性缓慢性心律失常的５例（３５．８％）均发生在下壁及（或）后壁梗死。ＲＡ的发生与再灌注前心肌缺血时间和缺血性心律失常存在与否无关，心肌功能严重受损患者可能更易发生ＲＡ。本文并就如何预防和治疗ＲＡ进行了探讨。

REPERFUSION ARRHYTHMIAS DURING INTRACORONARY THROMBOLYSIS IN ACUTE MYOCARDIAL INFARCTION

Intracoronary thrombolysis for twenty two patients with acute myocardial infarction(AMI) was reported.Reperfusion confirmed by immediate coronary angiography was achieved in 14 patients. Reperfusion arrhythmias(RA) occurred in 9(64. 3/00) of the patients, including idioventricular rhythm, a reliable indicator of coronary artery recanalization, in 3(21. 4 /00 ) . Transient bradycardia with hypotension occurred in 5(35. 8/00)patients. which was an indicator of recanalization of the coronary artery and salvage of myocardium in inferioposterior MI.The orcurrence of RA showed no correlation with the duration of ischemia and severity of ischemic arrhythmias before reperfusion. The patients with RA were treated by routine antiarrhythmic therapy including GIK-Mg2 solution and lidocaine. No death relatedto RA occurred.