摘要
目的探讨急性心肌梗死（AMI）患者发生恶性室性心律失常（MVA）的危险因素。方法回顾性分析2013年1月至2017年12月269例AMI患者的临床资料。根据患者30d内是否发生致死性心律失常，分为MVA组105例和非MVA组164例，采用单因素和多因素分析确定AMI患者30d内发生MVA的危险因素。结果269例AMI患者发生MVA105例，发生率39％。病变血管数、梗死部位、心电图Q波、低钾血症、心率变异性各指标降低、左室射血分数（LVEF〈40％）及cTnI升高与心肌梗死后患者MVA发生有关，差异有统计学意义（P〈0．05），而在年龄、性别、高血压病史、吸烟史及糖尿病史等方面比较，差异无统计学意义（P〉0．05）。进一步Logistics回归分析显示，多支血管病变、低钾血症、心率变异减低及LVEF〈40％是心肌梗死后发生恶性室性心律失常的独立危险因素（P〈0.05），行开通梗死相关血管（IRAPCI）术治疗是MVA的保护因素，可以有效降低MVA发生率。结论AMI后患者发生MVA危险因素较多，主要为低钾血症、多支血管病变、前壁梗死、心率变异减低和LVEF〈40％，临床应针对相关危险因素采取对预防措施，以降低AMI患者MVA的发生率，降低病死率。
Objective To investigate the risk factors of malignant ventricular arrhythmia （ MVA ） in patients with acute myocardial infarction. Methods The clinical data of 269 patients with acute myocardial infarction who received cardiology from January 2013 to December 2017 in our hospital were retrospectively analyzed. According to whether the patients had fatal arrhythmia within 30 days, they were divided into 105 cases in MVA group and 164 cases in non-MVA group. Univariate and multivariate analysis were used to determine the risk factors of MVA in patients with AMI within 30 days. Results A total of 105 cases of MVA were found in 269 patients with acute myocardial infarction. The incidence of MVA was 39%. The number of vascular lesion, infarction site, Q wave, hypokalemia and heart rate variability were all decreased. LVEF〈40 % ） And elevated cTnl were associated with MVA in patients with myocardial infarction （P〈0.05） , but no significant differences in age, sex, history of hypertension, smoking history and history of diabetes （ P〉 0.05 ） . Further logistic regression analysis showed that rnultivessel disease, hypokalemia, reduced heart rate variability, and LVEF〈40% were independent risk factors for developing malignant ventricular arrhythmias after myocardial infarction （ P〈0.05 ） . IRA surgery was a protective factor of MVA, effectively reduced the incidence of MVA. Conclusions There are many risk factors for MVA in patients with acute myocardial infarctions, mainly including hypokalemia, multivessel disease, reduced heart rate variability and LVEF〈40%. The preventive measures should be taken according to the relevant risk factors in order to reduce the incidence of MVA in patients with acute myocardial infarction and reduce mortality.
出处
《浙江临床医学》
2018年第7期1204-1205,共2页
Zhejiang Clinical Medical Journal
关键词
急性心肌梗死
恶性室性心律失常
危险因素
预防措施
Acute myocardial infarction Malignant ventricular arrhythmias Risk factors Preventive measures
