镁对急性心肌梗死溶栓并发再灌注心律失常的抑制作用  

Suppresion of thrombolysis-induced reperfusion arrhythmias in acute myocardial infarction by magnesium sulfate

作　　者：周红勤[1] 胡婵[1] 孙明[2] 王钟林[3] 李柳南[4] 郑再德 刘志雄 宋菊桂 

机构地区：[1]邵阳市第一人民医院心内科,湖南邵阳422001 [2]湖南医科大学湘雅医院 [3]湖南医科大学附属第二医院 [4]湖南医科大学附属第三医院 [5]邵阳市中心医院 [6]娄底地区卫校

出　　处：《临床心血管病杂志》2000年第4期156-158,共3页Journal of Clinical Cardiology

摘　　要：目的 :探讨尿激酶 (U K)静脉溶栓治疗急性心肌梗死 (AMI)时再灌注心律失常 (RAs)的发生情况 ,评价硫酸镁 (MS)对 RAs的抑制作用。方法 :32 2例 AMI住院患者接受 U K溶栓治疗 ,将其中 15 1例随机分为 U M组 (UK加 MS,76例 )和 U K组 (75例 ) ,U M组在静脉滴注 U K前 15 min开始静脉注射 MS。结果 :根据临床标准判定为再灌注的患者 2 16例 (6 7.1% ) ,其中 190例 (88.0 % )于再灌注过程中出现心律改变 ,170例 (78.7% )出现RAs,其中室性 RAs 119例 (5 5 .1% )。预防性静脉注射利多卡因与否 ,对室性 RAs的发生无显著影响 (P >0 .0 5 )。U M组 RAs及严重心律失常 (SA)、室性 RAs的发生率均显著低于 UK组 (P<0 .0 1,P<0 .0 0 5 )。结论 :RAs是 AMI溶栓治疗的重要并发症 ;利多卡因不能预防室性 RAs的发生 ;MS对 RAs(尤其是室性 RAs)Objective:To explore the occurrences of thrombolysisinduced reperfusion arrhythmias (RAs) in acute myocardial infarction (AMI) and assess the inhibitory effect of intravenous magnesium sulfate (MS) on RAs.Method:322 patients with AMI admitted to six hospitals were treated with urokinase (UK) from December 1991 to January 1999.151 cases of them were randomly divided into UK plus MS (UM,76 cases) and UK (75 cases) groups.In UM group MS was begun to use at 15 minutes before intravenous UK.Result:The total reperfusion within 3 hours confirmed by clinical standard was achieved in 216 cases ( 67.1 %).RAs occurred in 170( 78.7 %) of the patients,including ventricular tachyarrhythmias in 119 ( 55.1 %).The incidence of ventricular RAs in patients with preventive intravenous lidocaine was 56.5 % versus 60% in those without that (P> 0.05 ).In comparison with UK group,frequencies of RAs ( 64.3 % vs 87.8 %) and severe arrhythmias ( 10.5 % vs 28%) after treatment were significantly reduced (all P< 0.01 )in UM group and ventricular RAs ( 57.1 % to 89.8 %,P< 0.05 ) was more lower in UM group,too.Conclusion:RAs are major complications of thrombolytic therapy in AMI;ventricular RAs can′t be prevented by lidocaine;MS plays an important role in preventing RAs (especially ventricular tachyarrhythmias)and sever arrhythmias.

关 键 词：急性心肌梗死 溶栓疗法 硫酸镁 心律失常 

分 类 号：R542.220.6[医药卫生—心血管疾病] R541.705[医药卫生—内科学]