中国急救医学
中國急救醫學
중국급구의학
Chinese Journal of Critical Care Medicine
2015年
9期
819-822
,共4页
宋鹏伟%李娜%生力健%于江波%刘丕栋
宋鵬偉%李娜%生力健%于江波%劉丕棟
송붕위%리나%생력건%우강파%류비동
心肌梗死%临时起搏器%经皮冠状动脉介入治疗(PCI)%再灌注
心肌梗死%臨時起搏器%經皮冠狀動脈介入治療(PCI)%再灌註
심기경사%림시기박기%경피관상동맥개입치료(PCI)%재관주
Myocardial infarction%Temporary cardiac pacemaker%Percutaneous coronary intervention(PCI)%Reperfusion
目的：探讨保护性临时起搏器在急性下壁心肌梗死（ AIMI）窦性心律患者急诊经皮冠状动脉介入治疗（ PCI）再灌注过程中应用的可行性与效果。方法入选AIMI且术前为窦性心律患者，成功完成急诊PCI共121例，所有患者均于术前植入临时起搏器，以60次／min保护。其中76例患者在再灌注过程中临时起搏器保护性起搏，列为起搏组；另45例患者在再灌注过程中临时起搏器未起搏，列为非起搏组。观察两组患者的一般临床特征、冠状动脉病变特点、再灌注前应用阿托品后心率增幅、再灌注前后血压水平、再灌注后恶性室性心律失常的发生情况。结果起搏组再灌注后收缩压（ SBP）及舒张压（ DBP）较起搏组再灌注前及非起搏组再灌注后明显降低（ P＜0．0001）；起搏组再灌注后恶性室性心律失常发生率与非起搏组比较差异无统计学意义（P＞0．05）。非起搏组冠状动脉右优势型比例明显低于起搏组（P＝0．0049），存在逆向血流灌注的比例明显高于起搏组（ P＜0．0001）；应用阿托品后，非起搏组心率增幅程度明显高于起搏组（P＜0．0001）。结论保护性临时起搏虽然对AIMI急诊PCI过程中发生的再灌注低血压及再灌注恶性室性心律失常无明显保护作用，但基于临时起搏器对术中缓慢性心律失常的有效控制，仍有其应用必要性，且更适用于无逆向灌注及对阿托品反应差的患者。
目的：探討保護性臨時起搏器在急性下壁心肌梗死（ AIMI）竇性心律患者急診經皮冠狀動脈介入治療（ PCI）再灌註過程中應用的可行性與效果。方法入選AIMI且術前為竇性心律患者，成功完成急診PCI共121例，所有患者均于術前植入臨時起搏器，以60次／min保護。其中76例患者在再灌註過程中臨時起搏器保護性起搏，列為起搏組；另45例患者在再灌註過程中臨時起搏器未起搏，列為非起搏組。觀察兩組患者的一般臨床特徵、冠狀動脈病變特點、再灌註前應用阿託品後心率增幅、再灌註前後血壓水平、再灌註後噁性室性心律失常的髮生情況。結果起搏組再灌註後收縮壓（ SBP）及舒張壓（ DBP）較起搏組再灌註前及非起搏組再灌註後明顯降低（ P＜0．0001）；起搏組再灌註後噁性室性心律失常髮生率與非起搏組比較差異無統計學意義（P＞0．05）。非起搏組冠狀動脈右優勢型比例明顯低于起搏組（P＝0．0049），存在逆嚮血流灌註的比例明顯高于起搏組（ P＜0．0001）；應用阿託品後，非起搏組心率增幅程度明顯高于起搏組（P＜0．0001）。結論保護性臨時起搏雖然對AIMI急診PCI過程中髮生的再灌註低血壓及再灌註噁性室性心律失常無明顯保護作用，但基于臨時起搏器對術中緩慢性心律失常的有效控製，仍有其應用必要性，且更適用于無逆嚮灌註及對阿託品反應差的患者。
목적：탐토보호성림시기박기재급성하벽심기경사（ AIMI）두성심률환자급진경피관상동맥개입치료（ PCI）재관주과정중응용적가행성여효과。방법입선AIMI차술전위두성심률환자，성공완성급진PCI공121례，소유환자균우술전식입림시기박기，이60차／min보호。기중76례환자재재관주과정중림시기박기보호성기박，렬위기박조；령45례환자재재관주과정중림시기박기미기박，렬위비기박조。관찰량조환자적일반림상특정、관상동맥병변특점、재관주전응용아탁품후심솔증폭、재관주전후혈압수평、재관주후악성실성심률실상적발생정황。결과기박조재관주후수축압（ SBP）급서장압（ DBP）교기박조재관주전급비기박조재관주후명현강저（ P＜0．0001）；기박조재관주후악성실성심률실상발생솔여비기박조비교차이무통계학의의（P＞0．05）。비기박조관상동맥우우세형비례명현저우기박조（P＝0．0049），존재역향혈류관주적비례명현고우기박조（ P＜0．0001）；응용아탁품후，비기박조심솔증폭정도명현고우기박조（P＜0．0001）。결론보호성림시기박수연대AIMI급진PCI과정중발생적재관주저혈압급재관주악성실성심률실상무명현보호작용，단기우림시기박기대술중완만성심률실상적유효공제，잉유기응용필요성，차경괄용우무역향관주급대아탁품반응차적환자。
Objective This study evaluated the safety and efficacy of preventive cardiac pacing in acute inferior wall myocardial infarction patients with sinus rhythm treated by emergency percutaneous coronary intervention ( PCI ) .Methods In all the 121 patients with acute inferior wall myocardial infarction and sinus rhythm who underwent successful emergency PCI and were given temporary cardiac pacemaker before PCI , 76 patients underwent cardiac pacing and were taken as preventive temporary cardiac pacing group , while 45 patients did not undergo cardiac pacing and were taken as the non cardiac pacing group .We observed the patients for general clinical manifestations , coronary artery pathological features and HR before PCI reperfusion and after atropine used , BP before and after the reperfusion , the occurrence of malignant ventricular arrhythmia .Results SBP and DBP after reperfusion in cardiac pacing group was significantly lower than those before reperfusion in the same group (P<0.0001) and those in non cardiac pacing group .The occurrence rates of malignant ventricular arrhythmia after reperfusion did not show any significant differences between these groups (P>0.05).The percentage of dominant right coronary artery in non -cardiac pacing group was significantly lower than those in cardiac pacing group (P=0.0049).Both of the occurrence rates of reverse blood flow perfusion and the degree of increased heart rate after atropine used in the non -cardiac pacing group were higher than those in cardiac pacing group ( P <0.0001 ).Conclusion The temporary cardiac pacing has no preventive effect on hypotension and malignant ventricular arrhythmia after reperfusion in acute inferior wall myocardial infarction patients with sinus rhythm , however, temporary cardiac pacing could protect acuteinferior wall myocardial infarction patients from bradyarrhythmia during PCI , especially be applicable to the patients with non -reverse perfusion and poor response to atropine .
