CAJ | 학술논문

目的：探讨急诊经皮冠状动脉介入治疗（ PCI）发生再灌注心律失常的危险因素，为前瞻性护理提供依据。方法总结2011年6月-2013年6月急性ST段抬高型心肌梗死12 h内行急诊PCI患者123例，评估其术中再灌注心律失常发生率。将术中发生再灌注心律失常患者作为观察组（ n＝71），无再灌注心律失常作为对照组（n＝52），比较两组患者年龄、性别、糖尿病、高血压病、高脂血症、梗死前心绞痛、大量吸烟、情绪波动、CK-MB峰值、白细胞数增高、心力衰竭、心原性休克、多支血管病变、发病至PCI时间等可能的相关因素，应用 Logistic 回归多因素分析，评价再灌注心律失常独立的危险因素。结果123例患者行急诊PCI术中再灌注心律失常发生率为57．7％。两组患者梗死者心绞痛、吸烟＞20支/d、情绪冲动、CK-MB峰值、心力衰竭、多支血管病变、发病至PCI时间≤6 h患者比例比较差异有统计学意义（P＜0．05）；回归多因素分析提示，观察组中情绪波动、多支血管病变、发病至PCI时间≤6 h的患者均高于对照组（OR＞1，P＜0．05）；观察组中男性、梗死前心绞痛患者低于对照组（OR＜1，P＜0．05）。结论情绪波动、多支血管病变、发病至PCI时间≤6 h患者是发生再灌注心律失常最重要的危险因素；而男性、梗死前心绞痛，为再灌注心律失常的保护因素。在急诊PCI过程中要重视高危风险因素，严密观察心电监护，积极护理施救，使患者安全渡过手术期。
목적：탐토급진경피관상동맥개입치료（ PCI）발생재관주심률실상적위험인소，위전첨성호리제공의거。방법총결2011년6월-2013년6월급성ST단태고형심기경사12 h내행급진PCI환자123례，평고기술중재관주심률실상발생솔。장술중발생재관주심률실상환자작위관찰조（ n＝71），무재관주심률실상작위대조조（n＝52），비교량조환자년령、성별、당뇨병、고혈압병、고지혈증、경사전심교통、대량흡연、정서파동、CK-MB봉치、백세포수증고、심력쇠갈、심원성휴극、다지혈관병변、발병지PCI시간등가능적상관인소，응용 Logistic 회귀다인소분석，평개재관주심률실상독립적위험인소。결과123례환자행급진PCI술중재관주심률실상발생솔위57．7％。량조환자경사자심교통、흡연＞20지/d、정서충동、CK-MB봉치、심력쇠갈、다지혈관병변、발병지PCI시간≤6 h환자비례비교차이유통계학의의（P＜0．05）；회귀다인소분석제시，관찰조중정서파동、다지혈관병변、발병지PCI시간≤6 h적환자균고우대조조（OR＞1，P＜0．05）；관찰조중남성、경사전심교통환자저우대조조（OR＜1，P＜0．05）。결론정서파동、다지혈관병변、발병지PCI시간≤6 h환자시발생재관주심률실상최중요적위험인소；이남성、경사전심교통，위재관주심률실상적보호인소。재급진PCI과정중요중시고위풍험인소，엄밀관찰심전감호，적겁호리시구，사환자안전도과수술기。
Objective To explore the risk factors of reperfusion arrhythmia in emergency percutaneous coronary intervention ( PCI ) in order to provide the evidence for the prospective nursing .Methods One hundred and twenty-three ST elevated acute myocardial infarction patients with emergency PCI within 12 h from June 2011 to June 2013 were chosen , and the incidence rate of reperfusion arrhythmia during the operation was evaluated.Seventy-one patients with reperfusion arrhythmia during the operation were chosen as the observation group, and 52 patients without reperfusion arrhythmia were chosen as the control group .The age, gender, diabetes , hypertension , hyperlipidemia , preinfarction angina , heavy smoking , mood fluctuations , CK-MB peak value, increased white blood cell count , heart failure, cardiogenic shock, multi-vessel vascular lesions and attack-to-ballon time were compared between two groups . The multivariate logistic regression was used to evaluate the independent risk factors of the occurrence of reperfusion arrhythmia .Results The incidence rate of reperfusion arrhythmia in emergency PCI in patients was 57.7%(71/123).Return to multi-factor analysis ,the mood fluctuations , multi-vessel vascular lesions and attack-to-ballon time less than 6 h are the most important risk factors of the incidence of reperfusion arrhythmia .The male and preinfarction anginas are the protection factors.Conclusions We should pay attention to the high risk factors of reperfusion arrhythmia in emergency PCI, and observe the ECG monitoring closely , and carry out nursing and rescue actively so as to make the patients safety during the operation period .