天津医药

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急性心肌梗死伴阵发房颤的临床研究

范耀东,褚玉茹,阚建英   

  1. 天津市第二医院 心内科
  • 收稿日期:2010-04-16 修回日期:2010-06-12 出版日期:2010-12-15 发布日期:2010-12-15
  • 通讯作者: 范耀东

Clinical study of acute myocardia infarction with paroxysmal atrial fibrillation

  • Received:2010-04-16 Revised:2010-06-12 Published:2010-12-15 Online:2010-12-15

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摘要：

目的:探讨急性心肌梗死(AMI)合并阵发心房颤动(AF)患者AF复发的影响因素。方法:将120例AMI伴阵发AF患者,在随访1年期间依有无AF复发分为复发组和窦性心律(窦律)组,比较2组一般资料、病史、血清C反应蛋白(CRP)水平、低密度脂蛋白胆固醇(LDL-C)水平、左房内径(LAD)、左室射血分数(LVEF),评价心功能,同时比较不同治疗方法患者间的AF复发率。结果:复发组年龄、心功能分级、患高血压和前壁心肌梗死高于或多于窦律组,LVEF低于窦律组,LAD大于窦律组(P<0.05或P<0.01)。溶栓再通患者AF复发率低于未溶或未再通患者,服用他汀患者AF复发率低于未服用他汀患者(均P<0.05)。高龄、高血压病、前壁梗死、高CRP水平、LAD增大和心功能减退是AF复发的危险因素;溶栓再通、服用他汀是抑制AF复发的保护性因素(P<0.05或P<0.01)。结论:高龄、高血压、前壁梗死、LAD增大、心功能减退促使AF的复发;早期血运重建、应用他汀类药物可抑制AF复发。

关键词: 急性心肌梗死, 心房纤颤, 他汀, C反应蛋白

Abstract: （Abstract）Objective: To observe the clinical causes on the recurrences of atrial fibrillation (AF) of patients with acute myocardial infarction(AMI) and paroxysmal atrial fibrillation (AF). Methods: 120 cases of patients with AMI and AF are divided, on whether or not recurrence of AF happened in the one-year follow-up, into two groups: the recurrence group and the normal sinus rhythm (NSR) group. Such data as general information, medical history and treatment of patients of the two groups are compared. At the end of the one-year follow-up, examinations of the patients are conducted on C-reactive protein (CRP), low-density lipoprotein (LDL), left atrial diameter (LAD) and left ventricular ejection fraction (LVEF), and their cardiac function are examined and classified. Results: The averaged age of recurrence group were apparently higher than the NSR group (P<0.01). There were more cases with high blood pressure, anterior myocardial infarction (P<0.01or P<0.05) and lower cardiac function (P<0.01), reveal a lower LVEF (P<0.01) and a larger LAD (P<0.01). On the other hand, the NSR group have lower CRP and LDL (P<0.01) level. Observations on the different treatments showed that patients with successful intravenous thrombolysis and those with treatment of statins have significantly few cases of AF recurrence compared with patients without the application of intravenous thrombolysis and failure to reperfusion. Conclusion: Precipitating factors for the recurrence of AF include senior age, high blood pressure, anterior wall infarction, left atrial enlargement and deterioration of cardiac function. Therefore, early revascularization and treatment with statins are effective measures against the recurrence of AF.

Key words: Acute myocardia infarction (AMI), Atrial fibrillation, Statins, C-reactive protein (CRP)