75岁以上老年急性心肌梗死患者急诊介入术中发生室性心律失常电风暴的危险因素  

Risk factors for VAS in elderly AMI patients undergoing emergency PCI

作　　者：王忠民 毛海艳 刘煜昊 高传玉 陈岩 吴秀娟 程江涛 郑晓辉 刘伟利 Wang Zhongmin;Mao Haiyan;Liu Yuhao;Gao Chuanyu;Chen Yan;Wu Xiujuan;Cheng Jiangtao;Zheng Xiaohui;Liu Weili(Henan Provincial People＇s Hospital,Zhengzhou University People＇s Hospital,Fuwai Central China Cardiovascular Disease Hospital Cardiology Center,Zhengzhou 450000,Henan Province,China)

机构地区：[1]河南省人民医院郑州大学人民医院阜外华中心血管病医院心内科,郑州450000 [2]河南省职工医院心内科

出　　处：《中华老年心脑血管病杂志》2018年第9期944-948,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的探讨老年急性ST段抬高型心肌梗死(STEMI)患者行急诊PCI术中发生室性心律失常电风暴(VSA)的危险因素。方法收集急性STEMI且行急诊PCI术的老年患者142例,根据VSA发生情况分为VSA组28例,非VSA组114例,另根据治疗时间不同分为干预组80例,未干预组62例。未干预组年龄≥75岁12例,60~75岁50例;干预组年龄≥75岁29例,60~75岁51例。比较各组发生VSA的危险因素。结果未干预组年龄≥75岁患者VSA发生率明显高于60~75岁患者(41.7%vs 32.0%,P<0.05)。干预组年龄≥75岁患者VSA发生率明显高于60~75岁患者(13.8%vs 5.9%,P<0.05)。干预组年龄≥75岁患者VSA发生率明显低于未干预组年龄≥75岁患者,差异有统计学意义(P<0.05)。年龄≥75岁VSA患者心电图J波、QRS波、右冠状动脉、心动过缓、持续低血压以及TIMI 0级比例明显高于非VSA患者(P<0.05,P<0.01)。多元logisict回归分析显示,心电图J波、心肌肌钙蛋白Ⅰ、TIMI血流分级、持续低血压是年龄≥75岁患者发生VSA的独立危险因素(P<0.05,P<0.01)。结论提前干预老年急性STEMI患者高危因素,可降低VSA发生率,提高VSA治疗成功率,改善预后。Objective To study the risk factors for VSA in elderly acute STEMI patients undergoing emergency PCI.Methods One hundred and forty-two elderly acute STEMI patients undergoing emergency PCI were divided into VSA group（n=28）and non-VSA group（n=114）or into intervention group（n=80）and non-intervention group（n=62）.Of the patients in non-intervention group,12 were ≥75 years old and 50 were 60-75 years old.Of the patients in intervention group,29 were≥75 years old and 51 were 60-75 years old.The risk factors for VSA in different groups were compared and analyzed.Results The incidence of VSA was significantly higher in≥75 years old patients than in 60-75 years old patients of both non-intervention group and intervention group.The incidence of VSA was significantly lower in ≥75 years old patients of intervention group than in≥75 years old patients of non-intervention group（P〈0.05）.The ratio of J wave and QRS wave on ECG,RCA,bradycardia,persistent hypotension and TIMI 0 was significantly higher in VSA group than in non-VSA group（P〈0.05）.Multivariate logistic regression analysis showed that J wave on ECG,myocardial troponin I,TIMI and persistent hypotension were the independent risk factors for VSA in≥75 years old acute STEMI patients（P〈0.05,P〈0.01）.Conclusion Early intervention of high risk factors can reduce the incidence of VSA,increase the successful treatment rate of VSA and improve the outcome in elderly acute STEMI patients.

关 键 词：心肌梗死 电抗休克 反搏动术 心肌再灌注 

分 类 号：R542.22[医药卫生—心血管疾病] R541.7[医药卫生—内科学]