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目的:探讨急性心肌梗死(AMI)合并Ⅲ°房室传导阻滞(Ⅲ°AVB)患者恢复正常的房室结传导的影响因素。方法:选择AMI合并Ⅲ°AVB患者82例,根据Ⅲ°AVB是否恢复正常房室结传导分为恢复组51例,未恢复组31例(其中安装永久人工心脏起搏器3例,死亡28例)。观察两组Killip分级、心源性休克等因素的差异。结果:AMI合并Ⅲ°AVB患者中,房室结传导恢复组与未恢复组在年龄、性别比例、吸烟史、高血压病史、糖尿病史、缺血预适应、到达急诊室时间、入院心率水平、入院收缩压、血红蛋白水平及实施早期再灌注治疗方面,差异无显著性(P>0.05)。与恢复组比较,未恢复组Killip≥II级(39.2%比80.6%)、心源性休克(21.6%比45.2%)、前壁梗死比例(7.8%比32.3%)、肌酐水平[(107.25±6.69)μmol/L比(132.43±11.52)μmol/L]及死亡率(0%比90.3%)显著升高,而下壁梗死比例(92.2%比67.7%)显著降低,P<0.05或<0.01。多因素Logstic回归分析显示,Killip分级为影响AMI合并Ⅲ°AVB患者房室结功能恢复正常的独立预测因素(OR=0.190,P=0.002)。结论:Killip分级为影响急性心肌梗死合并Ⅲ°房室传导阻滞患者房室结功能恢复的独立预测因素。
Objective: To investigate the influencing factors of atrioventricular nodal conduction in patients with acute myocardial infarction (AMI) and Ⅲ ° atrioventricular block (Ⅲ ° AVB). Methods: Eighty-two AMI patients with Ⅲ ° AVB were selected. According to whether Ⅲ ° AVB returned to normal atrioventricular node conduction, there were 51 cases in the recovery group and 31 cases in the non-recovery group. Among them, 3 cases were equipped with permanent artificial pacemaker and 28 died ). The differences between the two groups in Killip grade and cardiogenic shock were observed. Results: Among patients with AMI complicated with Ⅲ ° AVB, there was no significant difference in the age, sex ratio, smoking history, history of hypertension, history of diabetes mellitus, ischemic preconditioning, time to emergency room, rate of admission heart rate, Admission systolic blood pressure, hemoglobin levels and the implementation of early reperfusion therapy, the difference was not significant (P> 0.05). Compared with the recovery group, Killip≥II (39.2% vs 80.6%), cardiogenic shock (21.6% vs 45.2%), anterior wall infarction (7.8% vs 32.3%) and creatinine [(107.25 ± 6.69) μmol / L (132.43 ± 11.52 μmol / L) and mortality (0% vs 90.3%), while the ratio of inferior wall infarction (92.2% vs 67.7%) was significantly lower than that of control . Multivariate Logistic regression analysis showed that Killip grade was an independent predictor of atrioventricular normograghia (OR = 0.190, P = 0.002) in patients with AMI complicated with Ⅲ ° AVB. Conclusion: Killip classification is an independent predictor of atrioventricular nodal recovery in patients with acute myocardial infarction complicated with Ⅲ ° atrioventricular block.