急性心肌梗死再灌注心律失常的分布特征及其与自主神经失衡的关系  

Distribution characteristics of reperfusion arrhythmias and the relationship between reperfusion arrhythmias and autonomic nervous imbalance in patients with acute myocardial infarction

作　　者：蒋桔泉[1] 丁世芳[1] 陈志楠[1] 卢青[1] 龚志刚[1] 李志刚[1] 彭毅[1] 

机构地区：[1]广州军区武汉总医院心血管内科,湖北武汉430070

出　　处：《心脏杂志》2015年第3期271-273,277,共4页Chinese Heart Journal

摘　　要：目的:观察急性ST段抬高型心肌梗死(STEMI)患者自主神经活性及再灌注心律失常(RA)特点,探讨自主神经在急性STEMI再灌注心律失常的作用及机制。方法:冠状动脉造影证实梗死血管完全闭塞的患者,12 h内完成急诊冠状动脉介入(PCI)治疗的108例,根据梗死相关动脉分组,以梗死后心率、血压情况,评估自主神经活性。分析RA分布特征及与自主神经失衡的关系。结果:RA总发生率为44%,右冠状动脉组RA发生率显著高于其他部位(65%vs.35%和33%,P<0.01),距开通时间愈短RA发生率愈高(P<0.05,P<0.01)。前降支组交感神经过度激活者增多,右冠状动脉组迷走神经过度激活者增多,两组有显著性差异。结论:STEMI梗死再灌注RA总发生率为44%,右冠状动脉发生率显著高于其他部位,距开通时间愈短发生率愈高,且RA与自主神经失衡有关。AIM： To observe the distribution characteristics of reperfusion arrhythmias and evaluate the relationship between the autonomic nerve imbalance and reperfusion arrhythmias in patients with acute ST-segment elevation myocardial infarction （STEMI） during direct percutaneous coronary intervention （PCI）. METHODS： All patients had PCI within 12 h after AMI. Those patients whose infarct-related artery was totally occluded were selected and divided into three groups （LAD group, LCX group and RCA group） according to infarction-related arteries. The autonomic nerve imbalance were evaluated by heart rate and blood pressure. RESULTS： The incidence of RA was 44% in all patients with AMI. RA occurred more often in patients with RCA infarction than other patients with LAD infarction or LCX infarction （65% vs. 35% and 33%, P 〈 0. 01 ）. RA occurred more often in patients with early reperfusion. Sympathetic overactivty often occurred in patients with LAD infarction. Vagal overactivity occurred often in patients with RCA infarction. There were significant differences between the two groups. CONCLUSION： The total incidence rate of RA after reperfusion with direct PCI was 44% in all patients with acute ST-segment elevation myocardial infarction. The incidence of RA in patients with RCA infarction was higher than in other patients. The earlier the reperfusion by PCI, the higher the incidence rate of RA. Reperfusion arrhythmia was associated with autonomic nervous imbalance in patients with AMI.

关 键 词：心肌梗死 急性 经皮冠状动脉介入治疗 再灌注心律失常 自主神经失衡 

分 类 号：R541.4[医药卫生—心血管疾病]