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目的探讨急性心肌梗死患者急诊经皮冠状动脉介入治疗(PCI)围手术期的病情特点,发生电风暴的相关危险因素。方法对116例急诊PCI患者的资料进行回顾性总结,将发生电风暴的患者纳入电风暴组,未发生电风暴的患者为对照组。电风暴定义为24h内自发室性心动过速或心室颤动≥2次,需要紧急治疗者(包括抗心律失常药物和电复律或电除颤)。结果116例急诊PCI患者围手术期发生电风暴20例,发生率17.2%。梗死相关动脉为左主干、右冠状动脉、前降支和回旋支的患者在围手术期电风暴发生率分别为60%、23.9%、12.5%和0。电风暴组的年龄、梗死相关动脉直径、心肌坏死标志物、再灌注心律失常发生率和病死率均高于对照组,梗死相关动脉开通后心肌梗死溶栓试验(TIMI)血流分级越高,电风暴发生率越低。结论急诊PCI围手术期发生电风暴最常见于梗死相关动脉为左主干的急性心肌梗死患者。梗死相关动脉直径、梗死相关动脉开通后TIMI血流分级以及再灌注心律失常是围手术期发生电风暴的主要危险因素。
Objective To investigate the characteristics of the perioperative period of emergency percutaneous coronary intervention (PCI) in patients with acute myocardial infarction and the related risk factors of electrical storm. Methods The data of 116 patients with emergency PCI were retrospectively summarized. The patients with electrical storm were included in the electrical storm group, and the patients without electrical storm were the control group. Electrical storm is defined as 24h spontaneous ventricular tachycardia or ventricular fibrillation ≥ 2 times, the need for emergency treatment (including anti-arrhythmic drugs and cardioversion or defibrillation). Results In 116 cases of emergency PCI, 20 cases of electric storm occurred in perioperative period, the incidence rate was 17.2%. The incidence of perioperative electrical storm was 60%, 23.9%, 12.5%, and 0 respectively in patients with infarct-related artery as left main trunk, right coronary artery, anterior descending branch and circumflex artery. Age, infarct-related arterial diameter, myocardial necrosis markers, reperfusion arrhythmia incidence and mortality were all higher in the electrotherapy group than those in the control group. The TIMI grade was higher in the infarct-related artery after the initiation of infarction, The lower the incidence of electrical storm. Conclusions The perioperative emergency staging of PCI is the most common type of acute myocardial infarction in which the infarct-related artery is the left main trunk. Infarct-related arterial diameter, TIMI flow grade after infarction-related artery opening, and reperfusion arrhythmia were the major risk factors for perioperative electrical storm.