ST段抬高型心肌梗死患者发生恶性室性心律失常的相关因素分析  

Risk Factors of Malignant Ventricular Arrhythmia in Patients with ST-Elevation Myocardial Infarction

作　　者：李勇[1] 吕树铮[2] 王绿娅[3] 马临安[1] 李志忠[1] 

机构地区：[1]首都医科大学附属北京安贞医院心肺血管抢救中心 [2]首都医科大学附属北京安贞医院心内科 [3]首都医科大学附属北京安贞医院北京市心肺血管疾病研究所

出　　处：《中国动脉硬化杂志》2011年第4期327-330,共4页Chinese Journal of Arteriosclerosis

基　　金：北京市科委重大科技支持项目(D0906006040191)

摘　　要：目的探讨ST段抬高型心肌梗死患者发生恶性室性心律失常的特点及其相关因素,以期提高ST段抬高型心肌梗死患者的成活率。方法选取ST段抬高型心肌梗死患者并行直接经皮冠状动脉介入术(直接PCI)371例,根据直接PCI结束前是否发生恶性室性心律失常(心室颤动和持续性室性心动过速),将其分为恶性室性心律失常组(38例)和非恶性室性心律失常组。对恶性室性心律失常与年龄、性别、既往心绞痛史、既往心肌梗死史、高血压史、糖尿病史、吸烟史、入院时心功能Killip分级、心肌梗死位置、单多支病变、罪犯血管、心肌梗死距采血时间、甘油三酯、胆固醇、高密度脂蛋白、低密度脂蛋白、糖化血红蛋白、纤维蛋白原、D-二聚体、尿素氮、肌酐、血钾、尿酸、血糖、白细胞、中性粒细胞百分比和血红蛋白等参数进行单因素相关分析和Logistic回归分析。结果最后进入回归方程的只有入院时心功能Killip分级和肌酐,贡献最大的是患者入院时心功能Killip分级。结论心功能Killip分级高是ST段抬高型心肌梗死患者直接PCI结束前发生恶性室性心律失常的重要危险因素。Aim To explore the characteristics and risk factors of malignant ventricular arrhythmia（MVA）in patients with ST-elevation myocardial infarction（STEMI）. Methods 371 patients with STEMI treated with primary percutaneous coronary intervention（PCI） were studied.STEMI patients were divided into MVA group（n=38） and the group without MVA according to whether patients with ventricular fibrillation and sustained ventricular tachycardia before and during primary PCI.Age,gender,history of angina,previous MI,history of hypertension,history of diabetes,history of smoking,Killip class,location of MI,number of vessels,crime vessel,time between onset of symptoms and admission,triglycerides,cholesterol,high density lipoprotein,low density lipoprotein,glycated hemoglobin,fibrinogen,D-dimer,blood urea nitrogen,creatinine,serum potassium,uric acid,blood glucose,leukocyte,neutrophil percentage,and hemoglobin were recorded and compared between MVA group and the group without MVA.The risk factors of MVA were determined by Logistic regression analysis. Results Logistic regression analysis showed the Killip class and creatinine were major risk factors of MVA in patients with STEMI.The highest contribution was Killip class. Conclusion Higher Killip class is a vital determinant of MVA in patients with STEMI before and during primary PCI.

关 键 词：冠状动脉疾病 ST段抬高型心肌梗死 恶性室性心律失常 心室颤动 室性心动过速 

分 类 号：R5[医药卫生—内科学]