钾镁合剂预处理在ST段抬高型心肌梗死急诊PCI术中的应用  

Application of potassium magnesium mixture on emergency percutaneous coronary intervention in patients with ST segment elevation myocardial infarction

作　　者：梁青龙[1] 韦方[1] 赵昌莉[1] 王咏梅[1] 冯琳[1] LIANG Qing-Long;WEI Fang;ZHAO Chang-Li(Department of Cardiology, Guizhou Provincial People′s Hospital, Guiyang 550002, Guizhou, China)

机构地区：[1]贵州省人民医院心内科

出　　处：《中国老年学杂志》2019年第18期4369-4372,共4页Chinese Journal of Gerontology

基　　金：贵州省科技计划项目(No.HL20157158)

摘　　要：目的探讨钾镁合剂预防ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入(PCI)治疗围术期恶性心律失常的疗效及安全性。方法 120例STEMI并拟行急诊PCI患者随机分为观察组和对照组各60例。观察组患者PCI术前给予钾镁合剂;对照组PCI术前给予等体积生理盐水,比较两组PCI耗时和X线曝光时间,治疗后心律失常发生率、心电图检查结果、实验室指标水平变化、并发症发生情况。结果观察组PCI术后24 h、48 h心律失常发生率均显著低于对照组(P<0.05)。两组手术时间差异具有统计学意义(P<0.05);两组X线曝光时间对比有统计学差异(P<0.001)。观察组患者治疗后的心电图检查结果与治疗前相比,心率(HR)降低,QT期间(QTc)延长,QT离散度(QTd)缩短,均有统计学差异(P<0.05);对照组患者在治疗前后HR、QTc、QTd均无明显差异(P>0.05)。心肌酶谱实验结果显示,治疗前,两组患者的B型脑钠肽(BNP)和肌酸激酶同工酶(CK-MB)水平无明显差别(P>0.05)。治疗后,观察组患者与治疗前比较BNP和CK-MB水平均显著下降(P<0.05)。两组休克和恶心呕吐的发生率无明显差别(P>0.05),但观察组皮疹、心力衰竭及房室传导阻滞的发生率较对照组明显降低(P<0.05)。结论 STEMI急诊PCI术前预防性应用钾镁合剂,可显著地减少PCI耗时和X线曝光时间,同时降低患者PCI围术期恶性心律失常的发生率。Objective To observe the efficacy of potassium magnesium mixture in the prevention of intra-and post-operative malignant arrhythmia after emergency percutaneous coronary intervention(PCI) in patients with ST segment elevation myocardial infarction(STEMI).Methods A total of 120 patients with STEMI and required treatment with PCI were selected from December 2016 to November 2018 and randomly divided into observation and control groups. Patients in observation group were treated with potassium magnesium mixture before PCI for preventive treatment. Patients in control group were treated with equal volume saline before PCI. The operational time, X-ray exposure time, the rate of malignant arrhythmia, the results of electrocardiogram examination, the levels of laboratory indexes and the rate of complications were observed in two groups after treatment. Results The incidence of arrhythmia at 24 h and 48 h after PCI in the observation group were lower than those of the control group, and the differences were statistically significant(P<0.05). The operational time, there was significant difference in operatirnal time and x-ray exposure time between observation and control groups(P<0.05). The patients in observation group had lower HR, longer QTc, and shorter QTd after treatment than those before treatment(P<0.05). There were no significant differences in HR, QTc, and QTd before and after treatment in control group(P>0.05). Before treatment, there was no difference in BNP and CK-MB between two groups(P>0.05). After treatment, the levels of BNP and CK-MB were decreased in observation group, but there were no statistically significant differences compared with before treatment(P>0.05). The complications of the two groups showed that there were no significant differences in the incidence of shock, nausea and vomiting between the two groups(P>0.05), but the incidence of rash, heart failure, and atrioventricular block were decreased in observation group, which were significantly different from control group(P<0.05). Conclusions

关 键 词：ST段抬高型心肌梗死 经皮冠状动脉介入 钾镁合剂 心律失常 

分 类 号：R542.2[医药卫生—心血管疾病]