中国医师杂志
中國醫師雜誌
중국의사잡지
JOURNAL OF CHINESE PHYSICIAN
2014年
6期
787-790
,共4页
心肌梗死/治疗%血管成形术,经腔,经皮冠状动脉%心律失常,心性%心动过速,室性%心室颤动
心肌梗死/治療%血管成形術,經腔,經皮冠狀動脈%心律失常,心性%心動過速,室性%心室顫動
심기경사/치료%혈관성형술,경강,경피관상동맥%심률실상,심성%심동과속,실성%심실전동
Myocardial infarction/therapy%Angioplasty,transluminal,percutaneous coronary%Arrhythmias,cardiac%Tachy-cardia,ventricular%Ventricular fibrillation
目的：观察急性ST段抬高型心肌梗死（ STEMI）行直接经皮冠状动脉介入治疗（ PCI）患者冠脉病变程度与恶性心律失常的关系，指导临床防治。方法采用回顾性分析的方法连续收集2008年1月至2010年12月中国医科大学附属第一医院心内科诊断为STEMI并行直接PCI的住院患者418例。入院后均给予心电监护观察，根据是否发生恶性心律失常[定义为持续性室速（ sVT）或室颤（ VF）]分为无sVT/VF和sVT/VF两组。在发生sVT/VF的患者中，按sVT/VF发生时间分为2组：术前sVT/VF组，术后sVT/VF组。计算STEMI患者的冠脉病变程度，统计Gensini评分＜60分、Gensini评分≥60分且＜120分、Gensini评分≥120分患者的sVT/VF发生情况。观察STEMI行直接PCI患者冠脉病变程度与恶性心律失常的关系。结果共有47例（11.2％）患者发生sVT/VF，直接PCI术前发生sVT/VF 22例（44.8％），术后发生25例（53.3％）。 sVT/VF组Killip分级＞I级、心率快、血压低、射血分数低（ P ＜0.05），Gensini评分分组间总sVT/VF及术前sVT/VF的发生率差异有统计学意义（7.1％vs 10.8％vs 20.5％， P ＝0.012；2.1％vs 5.9％vs 9.6％， P ＝0.045）；直接PCI Gensini评分分组间术后sVT/VF的发生率差异无统计学意义（5.0％vs 4.9％vs 11.0％， P ＝0.142）；用年龄（ x±2）、性别、高血压、糖尿病1∶2配对Logistic回归分析显示心率≥80次/min（ P ＝0.04， OR：2.667，95％CI：1.043～6.815）是术前发生sVT/VF的独立危险因素， Gensini评分不是术前发生恶性心律失常的独立危险因素。结论 STEMI行直接PCI患者中，冠脉程度越重术前恶性心律失常的发生率可能越高，但是术后的恶性心律失常发生率无明显差异。
目的：觀察急性ST段抬高型心肌梗死（ STEMI）行直接經皮冠狀動脈介入治療（ PCI）患者冠脈病變程度與噁性心律失常的關繫，指導臨床防治。方法採用迴顧性分析的方法連續收集2008年1月至2010年12月中國醫科大學附屬第一醫院心內科診斷為STEMI併行直接PCI的住院患者418例。入院後均給予心電鑑護觀察，根據是否髮生噁性心律失常[定義為持續性室速（ sVT）或室顫（ VF）]分為無sVT/VF和sVT/VF兩組。在髮生sVT/VF的患者中，按sVT/VF髮生時間分為2組：術前sVT/VF組，術後sVT/VF組。計算STEMI患者的冠脈病變程度，統計Gensini評分＜60分、Gensini評分≥60分且＜120分、Gensini評分≥120分患者的sVT/VF髮生情況。觀察STEMI行直接PCI患者冠脈病變程度與噁性心律失常的關繫。結果共有47例（11.2％）患者髮生sVT/VF，直接PCI術前髮生sVT/VF 22例（44.8％），術後髮生25例（53.3％）。 sVT/VF組Killip分級＞I級、心率快、血壓低、射血分數低（ P ＜0.05），Gensini評分分組間總sVT/VF及術前sVT/VF的髮生率差異有統計學意義（7.1％vs 10.8％vs 20.5％， P ＝0.012；2.1％vs 5.9％vs 9.6％， P ＝0.045）；直接PCI Gensini評分分組間術後sVT/VF的髮生率差異無統計學意義（5.0％vs 4.9％vs 11.0％， P ＝0.142）；用年齡（ x±2）、性彆、高血壓、糖尿病1∶2配對Logistic迴歸分析顯示心率≥80次/min（ P ＝0.04， OR：2.667，95％CI：1.043～6.815）是術前髮生sVT/VF的獨立危險因素， Gensini評分不是術前髮生噁性心律失常的獨立危險因素。結論 STEMI行直接PCI患者中，冠脈程度越重術前噁性心律失常的髮生率可能越高，但是術後的噁性心律失常髮生率無明顯差異。
목적：관찰급성ST단태고형심기경사（ STEMI）행직접경피관상동맥개입치료（ PCI）환자관맥병변정도여악성심률실상적관계，지도림상방치。방법채용회고성분석적방법련속수집2008년1월지2010년12월중국의과대학부속제일의원심내과진단위STEMI병행직접PCI적주원환자418례。입원후균급여심전감호관찰，근거시부발생악성심률실상[정의위지속성실속（ sVT）혹실전（ VF）]분위무sVT/VF화sVT/VF량조。재발생sVT/VF적환자중，안sVT/VF발생시간분위2조：술전sVT/VF조，술후sVT/VF조。계산STEMI환자적관맥병변정도，통계Gensini평분＜60분、Gensini평분≥60분차＜120분、Gensini평분≥120분환자적sVT/VF발생정황。관찰STEMI행직접PCI환자관맥병변정도여악성심률실상적관계。결과공유47례（11.2％）환자발생sVT/VF，직접PCI술전발생sVT/VF 22례（44.8％），술후발생25례（53.3％）。 sVT/VF조Killip분급＞I급、심솔쾌、혈압저、사혈분수저（ P ＜0.05），Gensini평분분조간총sVT/VF급술전sVT/VF적발생솔차이유통계학의의（7.1％vs 10.8％vs 20.5％， P ＝0.012；2.1％vs 5.9％vs 9.6％， P ＝0.045）；직접PCI Gensini평분분조간술후sVT/VF적발생솔차이무통계학의의（5.0％vs 4.9％vs 11.0％， P ＝0.142）；용년령（ x±2）、성별、고혈압、당뇨병1∶2배대Logistic회귀분석현시심솔≥80차/min（ P ＝0.04， OR：2.667，95％CI：1.043～6.815）시술전발생sVT/VF적독립위험인소， Gensini평분불시술전발생악성심률실상적독립위험인소。결론 STEMI행직접PCI환자중，관맥정도월중술전악성심률실상적발생솔가능월고，단시술후적악성심률실상발생솔무명현차이。
Objective To investigate the relationship between the severity of coronary artery disease and malignant arrhythmia in the acute ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), and guide clinical prevention and treatment .Methods By retrospective analysis method , 418 cases of hospitalized patients with a diagno-sis of STEMI undergoing direct PCI were continuously collected in the Department of Cardiology , the First Affiliated Hospital of China Medical University, from 2008 January to 2010 December.Electrocardiography (ECG) was given after admission.Those patients were divided into two groups according to whether the occurrence of malignant ventricular arrhythmias that was defined as sustained ventricu -lar tachycardia (sVT) or ventricular fibrillation (VF)].In sVT/VF patients, the preoperative and postoperative groups were divided according to sVT/VF time.The degree of coronary artery lesions was calculated in patients with STEMI .The incidence of sVT/VF was counted in each group with Gensini scores <60,≥60 and<120, and ≥120.The relationship between the severity of coronary le-sions and malignant arrhythmia was observed in STEMI undergoing direct PCI patients .Results ⑴In this study , a total of 47 cases ( 11.2%) occurred with sVT/VF in patients;Killip grade >I, fast heart rate , low blood pressure , and low ejection fraction were risk factors of sVT/VF( P <0.05).The occurrence of sVT/VF among the Gensini groups were significant difference (7.1%vs 10.8%vs 20.5%, P =0.012 ) .⑵The occurrence of sVT/VF was 44.8% ( 22 patients ) with direct PCI before operation; the preoperative sVT/VF rate among the Gensini groups had significant difference (2.1%vs 5.9%vs 9.6%, P =0.045).⑶The occurrence of sVT/VF is 53.3%(25 patients) with direct PCI after operation; the postoperative sVT/VF rate among Gensini groups had no significant difference(5.0%vs 4.9%vs 11.0%, P =0.142);⑷Paired with age ( x±2), gender, hypertension, and diabetes 1, Logistic re-gression analysis showed that the heart rate greater than 80 beats /min ( P =0.04 , OR:2.667 , 95%CI:1.043~6.815 ) was an independent risk factor of preoperative sVT/VF, that Gensini score was not an independent risk factor of preoperative malignant ar -rhythmia.Conclusions For STEMI PCI patients, the more serious the degree of coronary artery is , the higher may be preoperative malignant arrhythmia , while the postoperative malignant arrhythmia rate has no significant difference .
