急性ST段抬高型心肌梗死急诊PCI发生恶性心律失常临床特点及替罗非班的影响  

Malignant arrhythmias of patients with STEMI undergoing emergency PCI and the effect of tirofiban

作　　者：何胜虎[1,2] 周胜华[1] 张晶[2] 王雪飞[2] 王大新[2] 

机构地区：[1]中南大学湘雅二院 [2]江苏省苏北人民医院心内科

出　　处：《中国临床药理学与治疗学》2016年第4期432-435,共4页Chinese Journal of Clinical Pharmacology and Therapeutics

摘　　要：目的:探讨急性ST段抬高型心肌梗死(STEMI)患者直接冠状动脉介入治疗(PCI)发生恶性心律失常(MA)临床特点及替罗非班的影响。方法:对2009年1月至2013年8月390例STEMI患者直接PCI的临床资料进行分析研究。所有患者根据替罗非班使用情况分为替罗非班组及非替罗非班组,将24 h内自发室性心动过速(VT)、心室颤动(VF)或三度房室传导阻滞(AVB)≥1次,需紧急治疗者归入MA组,其余纳入非MA组,进行临床分析。结果:390例患者共发生MA28例,其中未使用替罗非班组MA发生23(23/192)例;使用替罗非班组发生5例(5/198)。发生MA组患者中TIMI 1级血流、心动过缓、持续性低血压、右冠脉闭塞发生率显著高于未发生MA的非MA组患者(P<0.05)。结论:梗死相关动脉(IRA)为右冠状动脉、TIMI分级1级、心动过缓及持续性低血压是STEMI急诊PCI发生MA的重要危险因素,应用替罗非班可以减少MA的发生,改善预后。AIM： To investigate the clinical characteristics of malignant arrhythmias（ MA） of patients with acute ST-segment elevation myocardial infarction（ STEMI） who undergoing emergency PCI and the effect of tirofiban. METHODS： Clinical datas of 390 patients with STEMI who undergone emergency PCI from January 2009 to August 2013 were analyzed. All the patients were separated into two groups（ tirofiban and non tirofiban）. The patients who needed emergency treatment within spontaneous ventricular tachycardia（ VT）,ventricular fibrillation（ VF） or third degree A-V block（ AVB）≥ 1 time in 24 h were classified as MA group,and the others were classified as control group. RESULTS： Malignant arrhythmia were occurred in 28 patients of 390,23 in non tirofiban group（ 23 /192）and 5 in tirofiban group（ 5 /198）. Incidence rates of TIMI1 flow grade,bradycardia,persistent hypotension,right coronary artery occlusion among the patients with MA were significant higher than those of non MA. CONCLUSION： Infarct-related artery（ IRA） of right coronary artery,TIMI1 flow grade,bradycardia and persistent hypotension are important risk factors of malignant arrhythmias among the patients with STEMI undergoing emergency PCI. After applying tirofiban,the prognosis could be improved and the incidence of MA could be reduced.

关 键 词：急性ST段抬高型心肌梗死 急诊介入治疗 恶性心律失常 替罗非班 

分 类 号：R543[医药卫生—心血管疾病]