中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2010年
4期
337-341
,共5页
周滔%周胜华%刘洁妮%沈向前%胡信群%方臻飞%赵延恕%唐建军%刘启明%李旭平%刘振江%吕晓玲
週滔%週勝華%劉潔妮%瀋嚮前%鬍信群%方臻飛%趙延恕%唐建軍%劉啟明%李旭平%劉振江%呂曉玲
주도%주성화%류길니%침향전%호신군%방진비%조연서%당건군%류계명%리욱평%류진강%려효령
血管成形术,经腔,经皮冠状动脉%心律失常%冠状动脉疾病
血管成形術,經腔,經皮冠狀動脈%心律失常%冠狀動脈疾病
혈관성형술,경강,경피관상동맥%심률실상%관상동맥질병
Angioplasty,transluminal,percutaneous coronary%An-hythmia%Coronary disease
目的 探讨急性心肌梗死患者急诊经皮冠状动脉介入治疗(PCI)围手术期发生电风暴的相关危险因素.方法 对228例急诊PCI患者的资料进行回顾性总结,将发生电风暴的患者纳入电风暴组,未发生电风暴的患者纳入对照组.电风暴定义为24 h内自发室性心动过速或心室颤动≥2次,需要紧急治疗者(包括抗心律失常药物和电复律或电除颤).结果 228例急诊PCI患者围手术期发生电风暴39例,发生率为17.1%.梗死相关动脉为左主干、右冠状动脉、前降支和回旋支的患者在围手术期电风暴发生率分别为55.6%、23.7%、12.4%和0.电风暴组的年龄、梗死相关动脉直径、肌酸激酶同工酶、肌钙蛋白T、再灌注心律失常发生率和病死率均高于对照组(P值分别为0.043、0.012、0.036、0.018、0.001、0.049).梗死相关动脉开通后心肌梗死溶栓试验(TIMI)血流分级越高,电风暴发生率越低.而性别、收缩压、舒张压、随机血糖、白细胞计数、高敏C反应蛋白在两组间差异无统计学意义.logistic多因素回归分析显示,梗死相关动脉直径(OR:2.381,95%CI:1.127～5.028,P=0.023)、梗死相关动脉开通后血流,TIMI分级(OR:4.744,95%CI:1.773～12.691,P=0.002)、再灌注心律失常(OR:12.680,95%CI:4.360～36.879,P:0.000)是急性心肌梗死急诊PCI围手术期发生电风暴的独立相关因素.结论 急诊PCI围手术期发生电风暴最常见于梗死相关动脉为左主干的急性心肌梗死患者.梗死相关动脉直径、梗死相关动脉开通后TIMI血流分级以及再灌注心律失常是围手术期发生电风暴的主要危险因素.
目的 探討急性心肌梗死患者急診經皮冠狀動脈介入治療(PCI)圍手術期髮生電風暴的相關危險因素.方法 對228例急診PCI患者的資料進行迴顧性總結,將髮生電風暴的患者納入電風暴組,未髮生電風暴的患者納入對照組.電風暴定義為24 h內自髮室性心動過速或心室顫動≥2次,需要緊急治療者(包括抗心律失常藥物和電複律或電除顫).結果 228例急診PCI患者圍手術期髮生電風暴39例,髮生率為17.1%.梗死相關動脈為左主榦、右冠狀動脈、前降支和迴鏇支的患者在圍手術期電風暴髮生率分彆為55.6%、23.7%、12.4%和0.電風暴組的年齡、梗死相關動脈直徑、肌痠激酶同工酶、肌鈣蛋白T、再灌註心律失常髮生率和病死率均高于對照組(P值分彆為0.043、0.012、0.036、0.018、0.001、0.049).梗死相關動脈開通後心肌梗死溶栓試驗(TIMI)血流分級越高,電風暴髮生率越低.而性彆、收縮壓、舒張壓、隨機血糖、白細胞計數、高敏C反應蛋白在兩組間差異無統計學意義.logistic多因素迴歸分析顯示,梗死相關動脈直徑(OR:2.381,95%CI:1.127～5.028,P=0.023)、梗死相關動脈開通後血流,TIMI分級(OR:4.744,95%CI:1.773～12.691,P=0.002)、再灌註心律失常(OR:12.680,95%CI:4.360～36.879,P:0.000)是急性心肌梗死急診PCI圍手術期髮生電風暴的獨立相關因素.結論 急診PCI圍手術期髮生電風暴最常見于梗死相關動脈為左主榦的急性心肌梗死患者.梗死相關動脈直徑、梗死相關動脈開通後TIMI血流分級以及再灌註心律失常是圍手術期髮生電風暴的主要危險因素.
목적 탐토급성심기경사환자급진경피관상동맥개입치료(PCI)위수술기발생전풍폭적상관위험인소.방법 대228례급진PCI환자적자료진행회고성총결,장발생전풍폭적환자납입전풍폭조,미발생전풍폭적환자납입대조조.전풍폭정의위24 h내자발실성심동과속혹심실전동≥2차,수요긴급치료자(포괄항심률실상약물화전복률혹전제전).결과 228례급진PCI환자위수술기발생전풍폭39례,발생솔위17.1%.경사상관동맥위좌주간、우관상동맥、전강지화회선지적환자재위수술기전풍폭발생솔분별위55.6%、23.7%、12.4%화0.전풍폭조적년령、경사상관동맥직경、기산격매동공매、기개단백T、재관주심률실상발생솔화병사솔균고우대조조(P치분별위0.043、0.012、0.036、0.018、0.001、0.049).경사상관동맥개통후심기경사용전시험(TIMI)혈류분급월고,전풍폭발생솔월저.이성별、수축압、서장압、수궤혈당、백세포계수、고민C반응단백재량조간차이무통계학의의.logistic다인소회귀분석현시,경사상관동맥직경(OR:2.381,95%CI:1.127～5.028,P=0.023)、경사상관동맥개통후혈류,TIMI분급(OR:4.744,95%CI:1.773～12.691,P=0.002)、재관주심률실상(OR:12.680,95%CI:4.360～36.879,P:0.000)시급성심기경사급진PCI위수술기발생전풍폭적독립상관인소.결론 급진PCI위수술기발생전풍폭최상견우경사상관동맥위좌주간적급성심기경사환자.경사상관동맥직경、경사상관동맥개통후TIMI혈류분급이급재관주심률실상시위수술기발생전풍폭적주요위험인소.
Objective To determine the prevalence and to identify risk factors of peri-procedure electrical storm (ES) in patients with acute myocardial infarction (AMI) underwent emergency percutaneous coronary intervention (PCI).Methods The clinical data of 228 AMI patients underwent emergency PCI were retrospectively analyzed and patients were divided into ES group (n = 39) and non-ES (n = 189) group.ES was referred to spontaneous ventricular tachycardia or ventricular fibrillation occurring twice or more within 24 h and requiring emergency treatment including anti-arrhythm medicine and/or cardioversion or defibrillation.Results ES was diagnosed in 39 out of 228 patients (17.1%) during peri-procedure stage.The incidence of ES in patients with various infarct related arteries (IRA) was as follows:55.6% with left main artery (LM),23.7% with right coronary artery (RCA),12.4% with anterior descending branch (LAD) and 0 with left circumflex artery (LCX).Older age,lager diameter of IRA,higher concentration of CK-MB and cTnT,higher incidence of reporfusion arrhythmia (RA),lower grade of TIMI after PCI and higher mortality were associated with increased risks of ES (The P value was 0.043,0.012,0.036,0.018,0.001,0.049,respectively).Gender,systolic pressure,diastolic pressure,random blood glucose level,white blood count and concentration of hs-CRP were similar between ES and non-ES patients.Logistic analysis showed that the diameter of IRA (OR 2.381,95% CI 1.127-5.028,P = 0.023),TIMI grade of IRA after PCI (OR 4.744,95% CI 1.773-12.691,P = 0.002) and RA (OR 12.680,95% CI 4.360-36.879,P =0.000)were the independent risk factors of per-procedure ES in AMI patients underwent emergency PCI.Conclusions The AMI patients with LM as IRA had the highest incidence of ES during emergency PCI and the diameter of IRA,TIMI grade of IRA after PCI and RA were independent risk factors for the development of ES during peri-PCI stage.
