急性下壁心肌梗死患者急诊经皮冠状动脉介入术后发生心室颤动的危险因素分析及术中阿托品的预防效果  

Analysis of risk factors for ventricular fibrillation after emergency percutaneous coronary intervention in patients with acute inferior myocardial infarction and the preventive effect of intraoperative usage of atropine

作　　者：常永茂[1] 席银娟[1] 刘昕 樊欣 赵生环 Chang Yongmao;Xi Yinjuan;Liu Xin;Fan Xin;Zhao Shenghuan(Department of Cardiology,Gansu Jiuquan People's Hospital,Jiuquan 735000,China)

机构地区：[1]甘肃省酒泉市人民医院心血管内科,735000

出　　处：《心脑血管病防治》2022年第2期32-36,共5页CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT

摘　　要：目的 探讨急性下壁心肌梗死患者急诊经皮冠状动脉介入术(PCI)后发生心室颤动的危险因素分析及术中应用阿托品的预防效果。方法 选取酒泉市人民医院2016年6月至2019年6月期间收治的急性下壁心肌梗死行急诊PCI手术的患者104例,按照随机分组的原则分为对照组和观察组,每组各52例,根据患者术后是否出现心室颤动将患者分为心室颤动组和无心室颤动组。观察组患者在行急诊PCI手术过程中均静脉注射足量阿托品,对照组则不给予阿托品干预。观察两组患者术后非致命性心肌梗死、反复缺血性心绞痛、猝死、无复流、心室颤动等不良事件的发生情况。采用Logistic回归分析与心室颤动发生有关的危险因素。结果 在预防性应用阿托品后,观察组患者无复流、心室颤动、反复缺血性心绞痛、非致命性心肌梗死、猝死等发生率和对照组比较明显降低(χ^(2)=5.976、8.253、5.342、5.021、4.472,P <0.05)。对心室颤动组和无心室颤动组的一般资料和心电图进行分析发现,两组既往心肌梗死史、β阻滞药、阿司匹林、入院时血钾水平、PCI术前心室颤动、症状发作到球囊扩张时间、左主干病变、右冠状动脉为罪犯血管、伴右心室心肌梗死、术前TIMI血流0级、术中使用阿托品、既往QRS时限、入院时ST段偏移总和> 1 500μV、入院时STmax> 300μV等方面差异均具有统计学意义(χ^(2)/t=4.438、4.041、4.438、2.407、4.438、4.299、5.393、8.914、4.379、4.093、8.143、2.064、4.158、3.934,均P <0.05);多元Logistic回归分析显示,患者发生心室颤动的危险因素包括ST偏移总和> 1 500μV、STmax> 300μV、右冠状动脉为罪犯血管、术前TIMI血流0级、左主干病变、症状发作到球囊扩张时间> 360 min、PCI术前心室颤动、既往心电图QRS时限延长、既往心肌梗死史、伴右心室心肌梗死;而患者发生心室颤动的的保护因素包括使用β阻滞�Objective To investigate the risk factors of ventricular fibrillation after emergency percutaneous coronary intervention(PCI) in patients with acute inferior myocardial infarction and the preventive effect of intra-operativeatropine treatment. Methods A total of 104 patients with acute inferior myocardial infarction, who underwent emergency PC, admitted to the Jiuquan People’s Hospital from June 2016 to June 2019 were selected. They were divided randomly into control group and observation group, with 52 patients in each group. After the operation, patients were divided into ventricular fibrillation group and non-ventricular fibrillation group based on whether ventricular fibrillation occurred after operation. Patients in the observation group received adequate intravenous injections of atropine during emergency PCI, while the control group did not given atropine intervention. The occurrence of adverse events such as non-fatal myocardial infarction, repeated ischemic angina, sudden death, no-reflow and ventricular fibrillation after PCI in the two groups were observed. Logistic regression analysis was used to analyze the risk factors related to occurrence of ventricular fibrillation. Results After the preventive application of atropine, the incidence of no reflow, ventricular fibrillation, recurrent ischemic angina pectoris, non-fatal myocardial infarction and sudden death in the observation group were significantly lower than those in the control group(χ^(2)=5.976, 8.253, 5.342, 5.021, 4.472;P < 0.05). The general data and ECG of ventricular fibrillation group and non ventricular fibrillation group were analyzed. There were statistically significant differences between the two groups in the history of previous myocardial infarction, β blockers treatment, aspirin treatment, potassium level at admission, occurrence of ventricular fibrillation before PCI, time from symptom onset to balloon dilatation, left main artery lesion, criminal right coronary artery, with right ventricular myocardial infarction, TIMI bloo

关 键 词：急性下壁心肌梗死 心室颤动 阿托品 

分 类 号：R542.22[医药卫生—心血管疾病]