摘要
目的探索老年急性ST段抬高型心肌梗死(STEMI)患者行经皮腔内冠状动脉介入治疗(PCI)发生室性心律失常风暴(VAS)的危险因素及早期干预效果。方法对2009年1月—2012年12月120例行PCI的老年STEMI患者的临床资料进行对照分析,将24 h内自发室性心动过速(VT)或心室颤动(VF)≥2次,需紧急治疗者归为实验组;其余患者归为对照组;将行PCI术前未经干预措施的老年STEMI患者归为早期亚组;将行PCI前予以干预措施(如给予阿托伐他汀或辛伐他汀)的老年STEMI患者归为晚期亚组。结果实验组患者的肌酸激酶同工酶(CK-MB)值、肌钙蛋白I(TNI)值、梗死相关动脉(IRA)为右冠状动脉、TIMI 0级血流、心动过缓、持续性低血压均显著高于对照组(P<0.05)。于2009年1月—2010年12月,电风暴发生7(7/42)例,发生率为16.7%。于2011年1月—2012年12月,针对危险因素进行PCI术前予以干预措施后,电风暴发生4例(4/78),发生率降为5.1%。结论 CK-MB值、TNI值、IRA为右冠状动脉、无血流、心动过缓、持续性低血压是发生电风暴的主要危险因素,针对这些危险因素积极采取早期干预措施,可以减少VAS的发生,改善预后。
Objective To explore the risk factors of ventricular arrhythmia storm （VAS） in elderly acute ST- segment elevation myocardial infarction （STEMI） patients with percutaneous transluminal coronary intervention （PCI） and evaluate the intervention efficacy. Methods Clinical materials of 120 elderly STEMI patients with PCI from January 2009 to December 2012 were ana- lyzed retrospectively. Patients with two or more occurrences of spontaneous ventricular tachycardia （VT） or ventricular fibrillation （VF） within 24 hours were designed as experimental group, and the rest patients were designed as control group. In the elderly STEMI patients with PCI, the patients without preoperative intervention were designed as early stage subgroup, and the patients with preoperative intervention （such as atorvastatin or simvastatin） were designed as advanced stage subgroup. Results The level of creatine kinase isoenzyme （CK - MB）, troponin I （TNI）level, the infarct - related artery （IRA） for the right coronary artery, TIMI 0 level of blood flow, bradycardia and persistent hypotension in the experimental group were significantly higher than those in the control group （P 〈 0.05）. 7 patients had VAS from January 2009 to December 2010, and the incidence rate was 16.7 % （7/42）. After application of preoperative intervention, 4 patients had VAS from January 2010 to December 2012, and the incidence rate was 5.1% （4/78）. Conclusion Levels of CK- ME, TNI, IRA for the right coronary artery, blood flow, bradycardia and persistent hypotension are the major risk factors for VAS. Implementations of preoperative interventions can reduce the incidence of VAS and improve the prognosis.
出处
《实用临床医药杂志》
CAS
2013年第23期8-11,共4页
Journal of Clinical Medicine in Practice
关键词
老年
急性心肌梗死
经皮腔内冠状动脉介入治疗
室性心律失常
危险因素
早期干预
risk factors
acute myocardial infraction
percutaneous transluminal coronary intervention
ventricular arrhythmia storm
early intervention
