STEMI直接PCI患者發生室顫的原因分析

吳龍梅 田新利 張健 王世宏 石宇杰 李俊峽

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STEMI直接PCI患者發生室顫的原因分析

吳龍梅 田新利 張健 王世宏 石宇杰 李俊峽

目的 觀察急性ST抬高心肌梗死（STEMI）患者直接經皮冠脈介入術（PCI）發生室顫的相關因素。方法 選擇2010年1月～2014年10月直接PCI的STEMI患者325例，分為發生室顫(VF)和無室顫兩組，分析發生室顫的相關因素。結果325例STEMI患者在PCI術中發生室顫24例，24例患者出現室顫時均需要電除顫復律，其中9例患者應用了抗心律失常藥物（胺碘酮、利多卡因）。兩組患者PCI術中均無死亡。兩組患者在年齡、性別、高血壓、糖尿病、吸煙、LVEF、血漿CK峰值、梗死部位、從發病至IRA開通時間上比較差異無統計學意義。VF組無復流發生率、低血鉀發生率較對無VT組升高（P＜0.05）。院內死亡3例，其中VF組1例，無VF組2例。結論 對于STEMI患者，應注意預防無復流及低血鉀的發生。

急性ST段抬高型心肌梗死；直接PCI；心室顫動

[ Abstract ] Objective To observe the relative factors of Ventricular Fibrillation(VF) in patients with ST-Elevation Myocardial Infarction (STEMI)undergoing primary percutaneous coronary intervention(PCI). Methods A total of 325 consecutive patients with STEMI who underwent primary PCI in General Hospital of Chinese PLA Beijing Military from January 2010 to October 2014. They were devided into 2 groups based on the patients with or without VF.All clinical data and characteristics of coronary lesion were compared between the two groups. Result Twenty-four(7.4%) patients occurred VF among these 325 STEMI patients when they were undergoing PCI. All these patients needed electric defibrillation when VF occurred.Nine of these 24 patients received antiarrhythmic drugs(amiodarone or lidocaine). No mortality was observed in all of the patients.There was no statistically significant difference in clinical data(age, gender, hypertension, diabetes mellitus,smoking, left ventricular ejection fraction),myocardial enzyme peak, infarction location,time from symptom onset to infarction related artery opening between the two groups(all p＞0.05). VF group had a higher incidence of no-reflow phenomenon (20.8% vs 8.3%,p＜0.05) and a lower serum potassium[(3.1±0.2) mmol/L vs (4.2±0.3)mmol/L, p＜0.01] than non-VF group.Three patients died in hospital:1 in VF group and 2 in non-VF group. Conelusion No-reflow phenomenon and hypokalemia are related to VF in patients with STMI undergoing primary PCI.Physicians should pay more attention to the prevention of no-reflow phenomenon and hypokalemia during PCI.

[ Key words ] ST-segment Elevation Myocardial Infarction; primary PCI; ventricular fibrillation近年來，經皮冠狀動脈介入術（PCl）已成為目前治療ST抬高急性心肌梗死（STEAMI）的主要方法，但PCI術中常發生心律失常特別是室顫（VF），是PCI手術中嚴重并發癥之一[1]。對這種可能發生的嚴重并發癥必須有足夠的認識，以便做出及時處理。本文通過回顧性研究，觀察2010年1月～2014年10月于我院行PCI的STEMI患者，分析PCI過程中發生室顫的相關危險因素。

1 資料與方法

1.1 研究對象 2010年1月至2014年10月符合急性STEMI接受急診PCI患者325人，年齡（62.7±10.9）歲，男性212例、女113例。入選標準：①典型的缺血性胸痛持續時間大于30 min，不超過12 h；②心電圖2個或2個以上相鄰導聯ST段抬高（胸導聯≥0.2 mV，肢體導聯≥0.1 mV）；③血管造影示靶血管閉塞或次全閉塞。……