急性心肌梗死再灌注心律失常不增加心肌损伤  

Reperfusion arrhythmias in acute myocardial infarction do not enhance myocardial injury

作　　者：罗义[1] 李广镰[1] 潘宜智[1] 曾冲[1] 雷晓明[1] 刘震[1] 冯开薇[1] 皮耀球[1] 吕磊[1] 

机构地区：[1]广州市第一人民医院心内科,510180

出　　处：《中华心血管病杂志》2007年第2期164-167,共4页Chinese Journal of Cardiology

摘　　要：目的探讨急性心肌梗死(AMI)患者 PCI 再灌注心律失常的临床意义。方法回顾性分析近年在我院接受直接 PCI 且成功开通梗死相关血管(IRA)的 AMI 患者228例。将其中开通IRA 后数分钟内发生心肌缺血再灌注损伤(MIRI)的119例患者(MIRI 组)分为3个亚组,即严重心动过缓和低血压(缓慢性心律失常组)、需电复律的严重室性心律失常(快速性心律失常组)和 IRA 前向血流≤TIMI 2级且除外急性闭塞(无复流组)。结果 (1)临床和造影资料:与无 MIRI 组相比,MIRI组缺血时间短,梗死前心绞痛所占比例低,多支血管病变、下壁梗死、右冠状动脉 IRA、PCI 前 IRA 血流 TIMI 0级和肾功能不全所占比例高,住院病死率较高(13.4%比4.6%,P=0.021)。(2)血清心肌酶水平:缓慢性心律失常组肌酸激酶(CK)峰值中位数显著低于无 MIRI 组(2010 IU/L 比2521 IU/L,P=0.039),肌酸激酶同工酶(CK-MB)峰值中位数有低于无 MIRI 组的趋势(98 IU/L 比142 IU/L,P=0.091);快速性心律失常组 CK 峰值中位数(2317 IU/L)和 CK-MB 峰值中位数(134 IU/L)与无MIRI 组相比差异无统计学意义(P=0.627,0.500);无复流组 CK 峰值中位数(4573 IU/L)和 CK-MB峰值中位数(338 IU/L)均显著高于无 MIRI 组(P 均=0.000)。(3)超声心功能:无复流组左心室射血分数显著低于无 MIRI 组(38.7%±8.3%比51.2%±8.1%,P=0.000),左心室舒张末期容积显著大于快速性心律失常组[(135±32)ml 比(105±19)ml,P=0.029],左心室收缩末期容积显著大于无 MIRI 组[(82±33)ml 比(54±24)ml,P=0.008]和缓慢性心律失常组[(56±19)ml,P=0.025]。结论再灌注心律失常可能提示梗死区存活心肌多,而且不增加心肌损伤;无复流增加心肌损伤,导致永久的心功能障碍。Objective To investigate the clinical implications of reperfusion arrhythmias during primary percutaneous coronary intervention （ PCI ） for patients with acute myocardial infarction （AMI）. Methods Data from 228 AMI patients in whom the infarct-related artery （IRA） were successfully recanalized by primary PCI were retrospectively analyzed. The 228 patients were divided into 2 groups： myocardial ischemia-reperfusion injury （MIRI） group （ n = 119 ） in whom MIRI events occurred within minutes after successful recanalization of IRA, and non-MIRI group （n = 109）. The 119 patients in MIRI group were further divided into 3 subgroups： severe bradycardia with hypotension （bredy-arrhythmia subgroup）, lethal ventricular arrhythmias requiting electrical cardioversion （tachy-arrhythmia subgroup）, and IRA antegrade flow less than or equal to TIMI 2 grade without angiographic evidence of abrupt closure （ no-reflow subgroup）. Results （ 1 ） Clinical and angiographic data： Compared with non-MIRI group, MIRI group was characterized by more inferior infarct location, shorter ischemic duration, more frequently right coronary artery as IRA, more diseased vessels, more often TIM10 grade of initial antegrade flow in IRA, less pre-infarction angina, more renal insufficiency, and higher in-hospital mortality （ 13.4% vs. 4. 6%, P =0. 021 ）. （2） The peak CK level was remarkably lower in brady-arrhythmia subgroup than that in non- MIRI group （2010 IU/L vs. 2521 IU/L, P =0. 039）. The peak CK or CK-MB level was notably higher in no-reflow subgroup than in non-MIRI group （4573 IU/L, 338 IU/L, respectively, P = 0. 000）. （3） Left ventricular ejection fraction in no-reflow subgroup was significantly lower than in non-MIRI group （38.7% ＋ 8.3% vs. 51.2% ＋ 8. 1%, P = 0. 000）, left ventricular end-diastolic volume in no-reflow subgroup was greater than that in tachy-arrhythmia subgroup [ （ 135 ± 32 ） ml vs. （ 105±19 ） ml, P = 0. 029 ]. Conclusion Reperfusion arrhythmias

关 键 词：心肌梗塞 心肌再灌注损伤 心律失常 血管成形术 经腔 经皮冠状动脉 

分 类 号：R542.22[医药卫生—心血管疾病]