保护性临时起搏对急性下壁心肌梗死急诊经皮冠状动脉介入治疗术中血流动力学和住院期间心血管事件的影响

摘要

目的：探讨保护性临时起搏对急性下壁心肌梗死（AIMI）急诊经皮冠状动脉介入（PCI）血流动力学和心血管事件的影响。方法：入选AIMI且行急诊PCI治疗者，其中常规放置保护性临时起搏者52例（起搏组）；非常规放置保护性临时起搏者68例（非起搏组）。观察两组再灌注前心率、平均血压水平；再灌注后血压水平；再灌注前后TIMI血流分级；再灌注后恶性室性心律失常的发生；住院期间严重心血管事件。结果：两组再灌注前心率、平均血压水平、再灌注后两组平均血压水平、再灌注前后TIMI血流分级差异无显著性（均P ＞0．05）；起搏组再灌注后恶性室性心律失常发生率较非起搏组高（P ＜0．01）；两组住院期间心力衰竭、再次非致命心梗发生率差异无显著性（均P ＞0．05），起搏组心源性死亡、全因死亡相对非起搏组明显增高，但差异无统计学意义（P ＞0．05）。结论：保护性临时起搏对 AIMI急诊PCI治疗术中血流动力学稳定无额外获益，反而增加恶性室性心律失常发生，可能增加死亡率。%Objective To evaluate the effects of preventive cardiac pacing on acute inferior wall myocardiac infarction ( AIMI ) . Methods A total of 52 patients were given preventive cardiac pacing before Percutaneous coronary intervention (PCI) (group T),while another 68 patients were not (group N).Heart rate and average blood pressure level before reperfusion, average blood pressure level after reperfusion,TIMI flow grade before and after reperfusion,the incidence of malignant ventricular arrhythmia after reperfusion and adverse cardiovascular events during hospitalization were compared in two groups. Results There were no significant differences in heart rate before reperfusion , average blood pressure levels before and after reperfusion , and the TIMI flow grade before and after reperfusion between two groups. The malignant ventricular arrhythmia after reperfusion in group T was significantly higher than that in group N while heart failure and nonfatal myocardial infarction were no significantly different between them. Mortality rate and mortality rate of cardiovascular disease in group T were higher than those in group N, but there were no significant differences between them. Conclusions The temporary cardiac pacing has no additional preventive effect on hemodynamic , but increases the occurrence of malignant ventricular arrhythmia , and the risk of death and cardiovascular events.