急性ST段抬高型心肌梗死患者并发恶性室性心律失常的危险因素及相关预防措施  

Risk factors and related preventive measures of malignant ventricular arrhythmia in patients with acute ST-elevation myocardial infarction

作　　者：杨雪 赵佳 黄盛楠 YANG Xue;ZHAO Jia;HUANG Shengnan(Coronary Care Unit,Beijing Daxing District People’s Hospital,Beijing 102600,China)

机构地区：[1]北京市大兴区人民医院冠心病重症监护室,北京102600 [2]北京市大兴区人民医院急诊重症监护室,北京102600

出　　处：《中国急救复苏与灾害医学杂志》2025年第4期421-424,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：首都卫生发展科研专项项目(2020-1-5023)。

摘　　要：目的 探究急性ST段抬高型心肌梗死(STEMI)患者并发恶性室性心律失常(MVA)的危险因素及相关预防措施。方法 选取北京市大兴区人民医院2020年1月—2023年1月收治的279例急性STEMI患者,根据是否并发MVA,分为MVA组(28例)、非MVA组(251例)。通过北京市大兴区人民医院电子病历系统选取收治的急性STEMI患者临床资料,统计MVA发生现状,通过单因素及多因素分析法分析急性STEMI患者并发MVA的危险因素,建立危险因素模型,并绘制受试者操作特征(ROC)曲线分析危险因素模型对急性STEMI患者并发MVA的预测价值。结果 279例急性STEMI患者并发MVA 28例,发生率为10.04%;年龄大、梗死部位为前壁、血糖水平、凯氏(Killip)分级Ⅲ~Ⅳ级是急性STEMI患者并发MVA的独立危险因素(OR=2.223、2.323、2.104、2.282,P<0.05),血钾水平是急性STEMI患者并发MVA的保护因素(OR=0.457,P<0.05)。构建回归模型:Logit(P)=-11.957+年龄大×0.799+梗死部位为前壁×0.843-血钾水平×0.782+血糖水平×0.744+Killip分级Ⅲ~Ⅳ级×0.825。当Logit(P)>13时,曲线下面积(AUC)值为0.855,敏感度、特异度分别为60.71%、90.84%。结论 急性STEMI患者并发MVA的发生率较高,年龄大、梗死部位为前壁、血糖水平高、Killip分级Ⅲ~Ⅳ级为其危险因素,血钾水平高为保护因素。构建的预测模型有较高的预测价值,临床可相应进行针对性防治。Objective To explore the risk factors of malignant ventricular arrhythmia(MVA) in patients with acute ST-elevation myocardial infarction(STEMI) and related preventive measures.Methods A total of 279 acute STEMI patients admitted to Beijing Daxing District People's Hospital from January 2020 to January 2023 were selected and divided into the MVA group(28 cases) and the non-MVA group(251 cases) according to whether they were complicated with MVA.According to the clinical data of acute STEMI patients admitted to the electronic medical record system of Beijing Daxing District People's Hospital,the incidence of MVA was analyzed,the risk factors of MVA in patients with acute STEMI were analyzed by univariate and multifactorial analysis,the risk factor model was established,and the predictive value of risk factor model in predicting MVA in patients with acute STEMI was analyzed by drawing receiver operating characteristic(ROC) curve.Results Among the 279 acute STEMI patients,28 cases were complicated with MVA(10.04%).Age,anterior infarction site,blood glucose level and Killip grade Ⅲ to Ⅳ were independent risk factors for MVA in acute STEMI patients(OR=2.223,2.323,2.104,2.282,P<0.05),serum potassium level was a protective factor for MVA in acute STEMI patients(OR=0.457,P<0.05).The regression model was constructed:Logit(P) =-11.957+ old age ×0.799+ infarct site was anterior wall ×0.843-blood potassium level ×0.782+ blood glucose level ×0.744+Killip grade Ⅲ to Ⅳ ×0.825.When Logit(P) >13,the area under the curve(AUC) value was 0.855,and the sensitivity and specificity were 60.71% and 90.84%,respectively.Conclusion The incidence of MVA was higher in acute STEMI patients.Older age,anterior infarction site,high blood glucose level,Killip grade Ⅲ to Ⅳ were the risk factors,and high blood potassium level was the protective factor.The prediction model built on this basis demonstrates a high level of predictive value,and the clinical prevention and treatment could be carried out accordingly.

关 键 词：急性ST段抬高型心肌梗死 恶性室性心律失常 受试者操作特征曲线 危险因素 预防措施 

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