目的 探讨急诊经皮冠状动脉介入治疗(PCI)治疗后的急性心肌梗死(AMI)患者恶性心律失常(MA)相关的危险因素.方法 选取经心电图检查确诊行PCI的AMI患者184例.根据患者术后72 h内有无MA分为MA组(n=51)和非MA组(n=133).观察AMI所累及的室壁、心功能Killip分级、AMI发病后至再通时间等基线资料和血肌酐、糖化血红蛋白、低密度脂蛋白-胆固醇水平、血钾、血糖、C反应蛋白、肌钙蛋白等各类生化指标.结果 MA组患者的心肌梗死区域所累及的室壁、心功能Killip分级、AMI发病后至再通时间、血肌酐、糖化血红蛋白、低密度脂蛋白、血钾、血糖、C 反应蛋白、肌钙蛋白较非MA组均差异有统计学意义(均P<0.05).多因素logistic回归分析结果显示,AMI发病后至再通时间于6 h之内(OR=2.239)、心肌梗死区域所累及的前壁(OR=2.675)、心功能KillipⅣ级(OR=7.127)、血肌酐高(OR=4.103)、糖化血红蛋白高(OR=4.212)、血钾低(OR=4.673)、血糖高(OR=2.104)、C 反应蛋白高(OR=2.167)和肌钙蛋白高(OR=1.817)均是AMI患者并发MA的危险因素(P<0.05).结论 AMI患者并发MA受心肌梗死区域所累及的室壁、心功能Killip分级、AMI发病后至再通时间、血肌酐、糖化血红蛋白、低密度脂蛋白、血钾、血糖、C反应蛋白以及肌钙蛋白多因素影响,应尽可能针对各种危险因素采取针对性的措施干预患者病情,减少MA的发生.%Objective To analyze the baseline data and biochemical indicators of patients with acute myocardi -al infarction after coronary intervention and to explore the risk factors associated with malignant arrhythmias.Methods A total of 184 cases of AMI patients treated with PCI were examined by ECG in the cardiac department of the people ′s hospital of DongYang City,Zhejiang Province.MA group(n=51)and non-ma group(n=133)were divided according to 72 hours after surgery.We observed the AMI patients with acute myocardial infarction areas involving Killip classifica -tion,room wall,and cardiac function after AMI onset to baseline data,such as the recanalization time and serum creati-nine,glycosylated hemoglobin,low density lipoprotein cholesterol levels,potassium,glucose,c-reactive protein,troponin and other kinds of biochemical index.Results Acute myocardial infarction areas involving,and cardiac function,the re-canalization after AMI onset time,creatinine,glycosylated hemoglobin,low density lipoprotein cholesterol levels,potassi-um,glucose,c-reactive protein,troponin of MA group were different from non MA group statistically(P<0.05).Mul-tiariable logistic regression analysis results showed that after the onset of AMI and recanalization time within 6 hours (OR=2.239),the involvement of the anterior wall myocardial infarction areas KillipⅣ(OR=2.675),and cardiac function(OR=7.127),serum creatinine level is high(OR=4.103),high glycosylated hemoglobin(OR=4.212),low potassium(OR=4.673),high blood sugar(OR=2.104),high(OR=2.167)and c-reactive protein troponin high (OR=1.817)were the risk factors of AMI patients complicated with MA(P<0.05).Conclusion Patients with acute myocardial infarction complicated with malignant arrhythmia in myocardial infarction area are affected by the room wall, cardiac function,Killip classification,recanalization after AMI onset time,creatinine,glycosylated hemoglobin,low densi-ty lipoprotein cholesterol levels,potassium,glucose,c-reactive protein and troponin factors,we should take corresponding measures as far as possible according to various risk factors to reduce the occurrence of malignant arrhythmia.
展开▼
