急性心肌梗死患者住院期间新发心房颤动的危险因素研究  

Risk Factors of New-onset Atrial Fibrillation in Patients with Acute Myocardial Infarction during Hospitalization

作　　者：刘莉莉[1] 冯雷[2] 王立君[1] 杜超[1] 秦利强[1] 卢炜[1] LIU Lili;FENG Lei;WANG Lijun;DU Chao;QIN Liqiang;LU Wei(Department of Cardiology,the Third Hospital of Shijiazhuang,Shijiazhuang 050011,China;Cardiothoracic Surgery,the Third Hospital of Shijiazhuang,Shijiazhuang 050011,China)

机构地区：[1]河北省石家庄市第三医院心内科,050011 [2]河北省石家庄市第三医院心胸外科,050011

出　　处：《实用心脑肺血管病杂志》2021年第2期38-41,共4页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：背景急性心肌梗死(AMI)是新发心房颤动(NOAF)的急性病因,而NOAF又可导致AMI病情恶化。因此,明确AMI患者NOAF的危险因素并早期干预对改善患者预后、降低病死率具有积极意义。目的探讨AMI患者住院期间NOAF的危险因素,以期能早期识别伴有高危心房颤动的AMI患者。方法本研究为回顾性研究。选取2014-06-01至2019-06-01石家庄市第三医院收治的648例AMI患者,其中住院期间出现NOAF 91例(房颤组);按照1∶2的比例从未出现NOAF的557例AMI患者中随机选取182例作为非房颤组。收集患者临床资料,包括一般资料、心脏超声检查结果、冠状动脉造影结果及住院期间严重临床事件发生情况。结果房颤组患者年龄和左心房内径(LAD)大于非房颤组,脑血管病、陈旧性心肌梗死、中重度左房室瓣反流、室性心动过速/心室颤动、心源性死亡发生率及收缩压<100 mm Hg、心率≥100次/min、左心室射血分数(LVEF)<40%者所占比例高于非房颤组,Killip分级劣于非房颤组(P<0.05)。多因素Logistic回归分析结果显示,年龄≥70岁[OR=3.636,95%CI(1.928,6.858)]、LAD>40 mm[OR=3.013,95%CI(1.475,6.158)]、收缩压<100 mm Hg[OR=5.056,95%CI(1.438,17.771)]、Killip分级≥2级[OR=4.130,95%CI(1.751,9.738)]是AMI患者NOAF的独立影响因素(P<0.05)。结论年龄≥70岁、LAD>40 mm、收缩压<100 mm Hg、Killip分级≥2级的AMI患者NOAF风险较高,应引起临床医生重视。Background Acute myocardial infarction(AMI)is an acute cause of new-onset atrial fibrillation(NOAF),which in turn might lead to the deterioration of AMI.Therefore,identifying the risk factors of NOAF and early intervention of them in patients with AMI have positive significance in improving prognosis and reducing mortality.Objective To investigate risk factors of NOAF in AMI patients during hospitalization,which might provide basis for early identification of AMI patients with high-risk atrial fibrillation.Methods This is a retrospective study.A total of 648 AMI patients who were hospitalized in the Third Hospital of Shijiazhuang from June 1,2014 to June 1,2019 were selected as study subjects.Among them,91 patients with NOAF during hospitalization were assigned to AF group.182 patients were randomly selected from 557 AMI patients without NOAF were assigned to non AF group according to the ratio of 1∶2.The clinical data of all study subjects were collected,including general information,echocardiography results,coronary angiography results and serious clinical events during hospitalization.Results Age and left atrium diameter(LAD)in AF group were greater than those in non AF group.The incidence of cerebrovascular disease,old myocardial infarction,moderate or severe mitral regurgitation,ventricular tachycardia/ventricular fibrillation,cardiac death,and the proportion of patients with systolic blood pressure(SBP)<100 mm Hg,heart rate≥100 beats/min,left ventricular ejection fraction(LVEF)<40%in AF group were higher than those in non AF group.Killip grade in AF group was worse than that in non AF group(P<0.05).Multivariate Logistic regression analysis showed that age≥70 years old〔OR=3.636,95%CI(1.928,6.858)〕,LAD>40 mm〔OR=3.013,95%CI(1.475,6.158)〕,SBP<100 mm Hg〔OR=5.056,95%CI(1.438,17.771)〕,and Killip grade≥2〔OR=4.130,95%CI(1.751,9.738)〕were independent risk factors of NOAF in AMI patients(P<0.05).Conclusion AMI patients with age≥70 years old,LAD>40 mm,SBP<100 mm Hg,or Killip grade≥2 have hig

关 键 词：心肌梗死 新发心房颤动 危险因素 

分 类 号：R542.22[医药卫生—心血管疾病]