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目的:分析冠状动脉介入中发生心室颤动(VF)的原因。方法:选择2005年1月～2006年12月行冠状动脉介入的患者1086例,回顾性总结冠状动脉介入检查、术中心电、压力监测等资料。结果:13例VF(发生率1.2)均为男性,其中因急性心肌梗死行急诊手术11例,择期手术2例。造影发现单支血管病变4例,2支病变4例,3支病变5例。VF发生在右冠状动脉10例,前降支冠状动脉1例。2例VF出现于冠状动脉造影术中,4例出现于冠状动脉介入治疗术中,6例出现于急性下壁心肌梗死PCI术前预防性安置心脏临时起搏器时。所有患者均经非同步直流电复律1次或多次、以及胸外心脏按压、用肾上腺素后抢救成功。结论:冠状动脉介入时发生的VF更多见于对右冠状动脉的操作中,其发生与急性心肌梗死、冠状动脉病变的严重程度、临时起搏电极的安置以及操作者的经验等因素有关。及时发现和处理得当,临床预后较好。
Objective: To analyze the causes of ventricular fibrillation (VF) during coronary intervention. Methods: A total of 1086 patients underwent coronary intervention from January 2005 to December 2006 were retrospectively reviewed. Coronary artery interventions, ECG and pressure monitoring were retrospectively reviewed. Results: Thirteen patients with VF (incidence 1.2) were all male, of whom 11 were emergency surgery and 2 were elective surgery due to acute myocardial infarction. Angiography showed single vessel disease in 4 cases, 2 lesions in 4 cases, 3 lesions in 5 cases. VF occurred in the right coronary artery in 10 cases, anterior descending coronary artery in 1 case. Two cases of VF appeared in coronary angiography, 4 cases occurred in coronary intervention, 6 cases occurred in acute inferior myocardial infarction PCI preoperative placement of temporary cardiac pacemaker. All patients were asynchronized DC cardioversion one or more times, as well as chest compression, with epinephrine rescue success. CONCLUSIONS: VF occurring during PCI is found more commonly in right coronary arteries and is associated with acute myocardial infarction, severity of coronary lesions, placement of temporary pacing electrodes, and operator experience. Timely detection and treatment, the clinical prognosis is good.