急性心肌梗死合并Ⅲ°房室传导阻滞恢复正常房室结传导的影响因素分析  

Influencing factor analysis of recovering to normal atrioventricular nodal conduction in patients with AMI complicated Ⅲ°AVB

作　　者：蔺红梅[1,2] 李帮清 

机构地区：[1]北京市西城区展览路医院内科病房,北京市100044 [2]北京大学人民医院

出　　处：《心血管康复医学杂志》2016年第1期41-44,共4页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的:探讨急性心肌梗死(AMI)合并Ⅲ°房室传导阻滞(Ⅲ°AVB)患者恢复正常的房室结传导的影响因素。方法:选择AMI合并Ⅲ°AVB患者82例,根据Ⅲ°AVB是否恢复正常房室结传导分为恢复组51例,未恢复组31例(其中安装永久人工心脏起搏器3例,死亡28例)。观察两组Killip分级、心源性休克等因素的差异。结果:AMI合并Ⅲ°AVB患者中,房室结传导恢复组与未恢复组在年龄、性别比例、吸烟史、高血压病史、糖尿病史、缺血预适应、到达急诊室时间、入院心率水平、入院收缩压、血红蛋白水平及实施早期再灌注治疗方面,差异无显著性(P>0.05)。与恢复组比较,未恢复组Killip≥II级(39.2%比80.6%)、心源性休克(21.6%比45.2%)、前壁梗死比例(7.8%比32.3%)、肌酐水平[(107.25±6.69)μmol/L比(132.43±11.52)μmol/L]及死亡率(0%比90.3%)显著升高,而下壁梗死比例(92.2%比67.7%)显著降低,P<0.05或<0.01。多因素Logstic回归分析显示,Killip分级为影响AMI合并Ⅲ°AVB患者房室结功能恢复正常的独立预测因素(OR=0.190,P=0.002)。结论:Killip分级为影响急性心肌梗死合并Ⅲ°房室传导阻滞患者房室结功能恢复的独立预测因素。Objective： To explore the influencing factors of recovering to normal atrioventncular nodal conouctmn （AVNC） in patients with acute myocardial infarction （AMI） complicated Ⅲ atrioventricular block （AVB）. Meth- ods： According to Ⅲ AVB recovered to normal or not, a total of 82 AMI complicated III AVB patients were divid- ed into recovery group （n = 51） and non - recovery group （n = 31, including three cases undergoing permanent pace- maker implantation and 28 dead cases）. The relationship among diabetes mellitus （DM） history, ischemic precondi- tioning （IP）, levels of creatinine （Cr） and hemoglobin （Hb） at hospitalization, systolic blood pressure （SBP）, Killip class, cardiogenic shock and recovering to normal AVNC etc. were observed in two groups. Results： There were no significant difference in age, sex proportion, smoking history, hypertension history, DM history, IP, duration from onset to arriving at emergency room, heart rate and SBP at hospitalization, Hb level and early reperfusion treatment between two groups, P〉0.05 all. Compared with recovery group, there were significant rise in percentages of Kil- lip≥class II （39.2% vs. 80.6%）, cardiogenic shock （21.6% vs. 45.2%）, anterior wall infarction （7. 8% vs. 32.3%）, Cr level [ （107.25±6. 69） μmol/L vs. （132.43 ± 11.52） μmol/L] and mortality （0% vs. 90.3%）, and significant reduction in percentage of inferior wall infarction （92.2% vs. 67.7%） in non - recovery group, P〈0.05 or 〈0.01. Multifactor Logistic regression analysis indicated that Killip class was theindependent predictor （OR = 0. 190, P = 0. 002） influencing recovering to normal AVNC in AMI ＋ Ⅲ° AVB patients. Conclusion： Killipclass is an independent predictor influencing recovering to normal AVNC in AMI ＋ Ⅲ° AVB patients.

关 键 词：心肌梗死 房室传导阻滞 影响因素分析 

分 类 号：R542.22[医药卫生—心血管疾病]