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投稿时间：2024-01-05 网络发布日期：2024-09-21
投稿时间：2024-01-05 网络发布日期：2024-09-21
中文摘要: 目的 研究急性ST段抬高型心肌梗死（STEMI）患者急诊介入治疗后再灌注心律失常(RA)的临床特点及危险因素。方法 选择襄阳市第一人民医院2017年1月至2022年1月确诊为急性STEMI且行经皮冠状动脉介入治疗（PCI）术的患者791例作为研究对象,根据是否发生RA分为RA组（n=390）及未发生RA组（NRA组,n=401），统计记录两组患者一般及临床资料，探讨急性STEMI PCI术后RA相关因素。结果 两组性别，年龄，高血压、糖尿病、吸烟、高脂血症、心房颤动史比较差异无统计学意义(P＞0.05)。RA组入院时收缩压、舒张压、心率及天门冬氨酸氨基转移酶（AST）均低于非RA组，左心室射血分数（LVEF）高于NRA组，差异有统计学意义(P＜0.05)。RA组从疼痛开始到治疗时间短于NRA组［(3.26±2.18)h? vs (4.70±2.65)h，t=8.334， P＜0.01］,主要不良心血管事件（MACE）事件发生率低于NRA组，差异有统计学意义(3.1%? vs 6.0%， χ2=3.849， P=0.049)。两组的心梗部位、梗死相关血管、术前罪犯血管病变情况差异有统计学意义(P＜0.05)。二元logistic分析显示，缺血时间＜6 h、术前罪犯血管病变严重程度、下壁及右冠状动脉梗死均为PCI术后RA发生的影响因素(P＜0.05)。结论 STEMI患者行PCI术后心律失常的发生与再灌注时间有关，应尽早完成PCI术。
中文关键词: 直接经皮冠状动脉介入治疗术 再灌注心律失常 总缺血时间 急性ST段抬高型心肌梗死
Abstract:Objective To study the clinical characteristics and risk factors of reperfusion arrhythmia (RA) after emergency interventional treatment in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods A total of 791 patients diagnosed with acute STEMI and underwent percutaneous coronary intervention (PCI) at Xiangyang No.1 People's Hospital from January 2017 to January 2022 were selected as the study subjects. They were divided into the RA group (n=390) and the non-RA (NRA) group (n=401) based on whether RA occurred. The general and clinical data of the two groups were recorded, and the related factors of RA after PCI for acute STEMI were explored. Results There was no statistically significant difference between the two groups in terms of gender, age, history of hypertension, diabetes, smoking, hyperlipidemia, and atrial fibrillation (P＞0.05). Compared with the NRA group, the systolic blood pressure, diastolic blood pressure, heart rate, and aspartate aminotransferase (AST) levels at admission were lower, while the left ventricular ejection fraction (LVEF) was higher in the RA group, with a statistically significant difference (P＜0.05). Compared with the NRA group, the time from onset of pain to treatment was shorter in the RA group ［(3.26±2.18) h? vs (4.70±2.65) h, t=8.334, P＜0.01］, and the incidence of major adverse cardiovascular events (MACE) was lower in the RA group (3.1%? vs 6.0%, χ2=3.849, P=0.049), with a statistically significant difference. There was a statistically significant difference in the location of myocardial infarction, infarct-related artery, and preoperative culprit vessel lesion between the two groups (P＜0.05). Binary logistic analysis showed that ischemic time ＜6 h, severity of preoperative culprit vessel lesions, inferior wall infarction and right coronary artery infarction were all related factors for the occurrence of RA after PCI (P＜0.05). Conclusion The occurrence of arrhythmia after PCI in STEMI patients is related to the reperfusion time, and PCI should be completed as soon as possible.
keywords: Direct percutaneous coronary intervention Reperfusion arrhythmia Total ischemic time Acute ST-segment elevation myocardial infarction
文章编号： 中图分类号：R543.3 文献标志码：A
基金项目:
| Author Name | Affiliation |
| YANG Pan， LIU Fuyuan | Postgraduate Training Base of Xiangyang No.1 People's Hospital Jinzhou Medical University, Xiangyang, Hubei 441000, China |
引用文本：
杨盼，刘福元.经皮冠状动脉介入术后再灌注心律失常：良性经过？还是恶性损伤？[J].中国临床研究,2024,37(9):1418-1422.
杨盼，刘福元.经皮冠状动脉介入术后再灌注心律失常：良性经过？还是恶性损伤？[J].中国临床研究,2024,37(9):1418-1422.