论文部分内容阅读
目的：研究ST段抬高型心肌梗死（ST segment elevation myocardial infarction,STEMI）患者急诊经皮冠状动脉介入术（percutaneous coronary intervention，PCI）后心肌缺血再灌注心律失常（reperfusionarrhythmia，RA）发生的影响因素并比较有无RA患者住院和术后1年主要不良心血管事件（major adverse cardiovascular events，MACE）的发生率。方法回顾性分析2012年1月~2013年5月在本院接受急诊PCI且血管重建成功的STEMI患者134例，分为RA组（89例）和无RA组（45例）2组。结果 RA组较无RA组相比，下壁心梗及术前TIMI 0级血流所占比例高、术前白细胞高，发病至血管再通时间更短，前壁心肌梗死所占比例低（均P＜0.05）；高血压、糖尿病、卒中病史患者RA发生率低（均P＜0.05）；下壁心梗（OR=3.617，95%CI：1.536-8.519，P=0.003）、术前TIMI0级（OR=2.477，95%CI：1.626-3.682，P=0.000）、发病至血管再通时间短（OR=1.144，95%CI：1.049-1.249，P=0.002）是RA的危险因素。在院及术后1年MACE发生率无统计学差异，但在院期间，RA组致命性心律失常发生率较高，有统计学意义。结论高血压、糖尿病、卒中病史患者RA发生率低；下壁心梗、术前TIMI0级、发病至血管再通时间短是RA的危险因素；RA可增加STEMI患者在院期间致命心律失常的发生率，但不影响在院和术后1年总的MACE发生率。“,”Objective To study the influence factors of reperfusion arrhythmia (RA) in patients with ST segment elevation myocardial infarction (STEMI)after emergency percutaneous coronary intervention (PCI), and to observe the incidence rates of major adverse cardiovascular event (MACE)during hospitalization and 1 year postoperatively between the patients with and without RA. Methods 134 STEMI patients, 108 males and 26 females, underwent emergency PCI successively. Peripheral blood samples were collected 6 h, 12 h, 24 h, and 48 h respectively to examine the peak values of serum cardiac tropnin I(cTnI),creatine kinase MB(CK-MB),and creatine kinase (CK). Concentration of white blood cells (WBCs) was counted. Electrocardiography was conducted. Electronic medical records, outpatient records, and telephine interview were used to obtain the information about MACE during hospitalization and within 1 yaer after discharge. Software SPSS 20 was used to analyze the data. Results RA was shown in 89 cases (RA group), and no RA was shown in 45 cases (no-RA group). Compared with the no-RA group, the percentages of inferior wall MI and TIMI flow grade 0 in the initial angiogram and preoperative white blood cell count were all significantly higher, time from onset to recanalization was significantly shorter in the RA group (all P<0.05). The peak velues of the 3 myocardial enzymes in the RA group were all significantly higher than those of the no-RA group (all P<0.05), both during hospitalization and 1 year after discharge. There was no significantly difference in the MACE rate both during hospitalization and 1 year after discharge, however, the fatal MACE rate during hospitalization of the RA group was05). Inferior wall myocardial infarction (OR=3.617,95%CI:1.536-8.519,P=0.003), TIMI flow grade 0 (OR=2.477,95%CI: 1.626-3.682,P=0.000), and time from onset to recanalization (OR=1.144,95%CI: 1.049-1.249,P=0.002) were risk factors for RA. Conclusion For the STEMI patients, the incidence of RA is low in those with hypertension, diabetes and stroke. Inferior wall myocardial infarction, TIMI flow grade 0 and time from onset to recanalization are risk factors for RA. RA may increase the incidence of fatal arrhythmia during hospitalization, but would not increase the total incidence of MACE during hospitalization and 1 year postoperatively.