心肌梗死急性期合并恶性室性心律失常患者的院内死亡危险因素资料分析  

Risk Factor Analysis for In-hospital Death in Patients With Acute Myocardial Infarction Combining Malignant Ventricular Arrhythmia

作　　者：王靖[1] 楚建民[1] 郭琦[1] 李烨[2] 陈旭华[1] 浦介麟[1] 华伟[1] 张澍[1] 

机构地区：[1]中国医学科学院北京协和医学院心血管病研究所阜外心血管病医院心律失常诊治中心,北京市100037 [2]中国医学科学院北京协和医学院心血管病研究所阜外心血管病医院门诊部,北京市100037

出　　处：《中国循环杂志》2014年第6期420-423,共4页Chinese Circulation Journal

摘　　要：目的：分析心肌梗死急性期合并恶性室性心律失常（MVA漶者的院内死亡危险因素。方法：入选2006—01至2010—12间急性心肌梗死合并MVA的患者224例，平均年龄（60．2±12．1）岁，男性173例。分为存活出院组和院内死亡组。对比两组间临床特征，分析影响存活出院率的相关因素。结果：两组基线状态对比显示，存活出院组男性比例更高，年龄更轻，心功能更好，合并糖尿病及有心绞痛病史者更少，急性心肌梗死发作距MVA间隔时间更短，肌酐平均水平更低，血清钾正常范围但平均水平更低，体表心电图中J波的检出率更低。采用多元Logistic回归分析结果显示，NYHA高于I级（危险比：5．67；95％CI：1．46～22．03；P=0．01），血清肌酐水平高于正常（危险比：5．26；95％CI：2．10—13．17；P〈0．01），心电图存在J波（危险比：4．37；95％CI：1．82～10．48；P=0．01），急性心肌梗死发作距MVA间隔时间超过24小时（1～13天危险比：3．00；95％CI：1．29。6．93；P_0．01。14～30天危险比：3．41；95％CI：1．40—8．31；P〈0．01），均为急性心肌梗死合并MVA患者的院内死亡的独立相关危险因素。结论：心肌梗死急性期合并MVA患者临床心功能越差，合并肾功能不全，体表心电图检出J波，以及MVA发作距离心肌梗死的时间超过24小时，都意味着院内死亡率增加。Objective： To analyze the risk factors for in-hospital death in patients with acute myocardial infarction （AMI） combining malignant ventricular arrhythmia （MVA）. Methods： A total of 224 AMI patients combining MVA treated in our hospital from 2006-01 to 2012-12 were summarized. There were 173 male, and the average age of the patients was at （60.2±12.1） years. The patients were divided into 2 groups, Survival group, n=155 and Death group, n=69. The clinical characteristics and the risk factors for in-hospital death were analyzed and compared between 2 groups. Results： In Survival group, the patients were more male, with younger age and better NYHA class, there were fewer patients with diabetes mellitus and the history of angina. The patients had shorter period from AMI to the first onset of MVA, had lower serum levels of creatinin and K~, lower rate of J wave in ECG. Multivariate logistic analysis revealed that NYHA higher than I, abnormal kidney function, presence of J wave in ECG, the period from AMI to the first onset of MVA longer than 24 hours were the independent risk factors for in-hospital death in AMI patients combining MVA. Conclusion： Higher NYHA class, abnormal kidney function,~ J wave presence in ECG and the period of AMI to the first onset of MVA longer than 24 hours were the risk factors for increasing the in-hospital death in AMI patients combining MVA.

关 键 词：急性心肌梗死 恶性室性心律失常 危险因素 J波 院内死亡 

分 类 号：R54[医药卫生—心血管疾病]