CAJ | 학술논문

目的探索急性ST段抬高型心肌梗死(STEMI)患者直接冠状动脉介入治疗(PCI)发生室性心律失常风暴(VAS)的危险因素及早期预防的效果.方法对2008年1月至2011年12月280例STEMI患者直接PCI的临床资料进行回顾性分析研究.将24h内自发室性心动过速(VT)或心室颤动(VF) ≥2次,需紧急治疗者归入VAS组,其余纳入对照组.结果 280例患者共发生VAS 19例,其中2008年1月至2009年12月(早期),电风暴发生16 (16/122)例;2010年1月至2011年12月(后期),电风暴发生3例(3/158).VAS组肌酸激酶同功酶(CK-MB)值、肌钙蛋白I(TNI)值、梗死相关动脉(IRA)为右冠状动脉、TIMI1级血流、心动过缓、持续性低血压显著高于对照组(P＜0.05).Logistic回归分析显示,TNI值、TIMI分级、持续性低血压是急性STEMI患者发生VAS的独立相关因素.结论 CK-MB值、TNI值、IRA为右冠状动脉、TIMI分级、心动过缓、持续性低血压是发生电风暴的主要危险因素,TNI值、TIMI分级、持续性低血压预测意义更强,针对危险因素积极采取早期干预措施,可以减少VAS的发生,改善预后.
목적 탐색급성ST단태고형심기경사(STEMI)환자직접관상동맥개입치료(PCI)발생실성심률실상풍폭(VAS)적위험인소급조기예방적효과.방법 대2008년1월지2011년12월280례STEMI환자직접PCI적림상자료진행회고성분석연구.장24h내자발실성심동과속(VT)혹심실전동(VF) ≥2차,수긴급치료자귀입VAS조,기여납입대조조.결과 280례환자공발생VAS 19례,기중2008년1월지2009년12월(조기),전풍폭발생16 (16/122)례;2010년1월지2011년12월(후기),전풍폭발생3례(3/158).VAS조기산격매동공매(CK-MB)치、기개단백I(TNI)치、경사상관동맥(IRA)위우관상동맥、TIMI1급혈류、심동과완、지속성저혈압현저고우대조조(P＜0.05).Logistic회귀분석현시,TNI치、TIMI분급、지속성저혈압시급성STEMI환자발생VAS적독립상관인소.결론 CK-MB치、TNI치、IRA위우관상동맥、TIMI분급、심동과완、지속성저혈압시발생전풍폭적주요위험인소,TNI치、TIMI분급、지속성저혈압예측의의경강,침대위험인소적겁채취조기간예조시,가이감소VAS적발생,개선예후.
Objective To investigate the risk factors for occurrence of electrical storm in the patients with acute ST segment elevation myocardial infarction (STEMI) when treat them by percutaneous coronary intervention (PCI) and provide evidence for prospective treatment.Methods Collected the clinical data of 280 patients with STEMI and treated by PCI from January 2008 to December 2011,the patients with no less than twice spontaneous ventricular tachycardia (VT) or ventricular fibrillation (VF) were classified to the electrical storm group and others were classified to control group.Results The number of patients with electrical storm is nineteen and the incidence rate is 6.8％.In early group (from January 2008 to December 2009),the number of patients with electrical storm is sixteen.In late group (from January 2010 to December 2011),the number of patients with electrical storm is three.The electrical storm group:The value of creatine kinase isoenzyme MB (CK-MB),the value of troponin I (TNI),right coronary artery being the infarction related artery (IRA),TIMI level,bradycardia and sustained hypotension in the electrical group are significantly higher than those of control group (P ＜ 0.05).Multiple logistic regression analysis showed that the independent predictors of VAS were the value of troponin I (TNI),TIMI level and sustained hypotension.Conclusions The value of creatine kinase isoenzyme MB (CK-MB),the value of troponin I (TNI),right coronary artery being the infarction related artery (IRA),TIMI level,bradycardia and sustained hypotension are the risk factors for occurrence of electrical storm.the value of troponin I (TNI),TIMI level and sustained hypotension were stronger predictors of electrical storm.Early treatment to the risk factors can reduce the incidence of VAS,and improve the prognosis.