老年冠心病患者發(fā)生心律失常類型臨床相關(guān)因素分析
發(fā)布時(shí)間：2019-03-29 19:03
【摘要】：目的:分析老年冠心病患者發(fā)生房性心律失常及室性心律失常兩種心律失常類型與血管病變支數(shù)、血漿BNP、血清鉀濃度、左心室舒張末期內(nèi)徑及左心室射血分?jǐn)?shù)的關(guān)系。方法:634例經(jīng)結(jié)合臨床癥狀及冠狀動(dòng)脈造影診斷為冠心病的老年患者,年齡均大于60歲,根據(jù)其臨床表現(xiàn)及輔助檢查結(jié)果,分為急性冠脈綜合征(acute coronary syndrome,ACS)和慢性缺血綜合征(chronic ischemic syndrome,CIS)兩組,記錄各組24小時(shí)動(dòng)態(tài)心電圖變化(Holter)明確24小時(shí)內(nèi)所發(fā)生的的心律失常類型,進(jìn)一步分析兩組患者發(fā)生房性及室性心律失常類型與血管病變支數(shù)、血清鉀濃度、血漿BNP值、左心室射血分?jǐn)?shù)、左心室舒張末期內(nèi)徑值的關(guān)系。結(jié)果:1、老年急性心肌缺血與慢性心肌缺血兩組心律失常發(fā)生類型:ACS組與CIS組心律失常類型:ACS組患者共有476例,其中,房性期前收縮:144例,房性心動(dòng)過速38例,心房顫動(dòng)110例,室性期前收縮138例,室性心動(dòng)過速34例,心室顫動(dòng)12例;CIS組患者共有158例,其中,房性期前收縮18例,房性心動(dòng)過速8例,心房顫動(dòng)46例,室性期前收縮62例,室性心動(dòng)過速22例,心室顫動(dòng)2例。2、老年ACS組心律失常類型(房性及室性)臨床相關(guān)因素及相關(guān)性:(1)血清鉀濃度可影響心律失常發(fā)生類型:血鉀低于正常值時(shí),室性心律失常發(fā)生率更高,差異有統(tǒng)計(jì)學(xué)意義(占67.80%,P0.05)。(2)冠脈多支病變時(shí)心律失常的發(fā)生率高于單支病變,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。當(dāng)BNP升高、LVEF下降及LVDD增大時(shí),房性心律失常發(fā)生率高于室性心律失常,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。3、老年CIS組心律失常類型(房性及室性)臨床相關(guān)因素及相關(guān)性:(1)血漿BNP水平升高、左室射血分?jǐn)?shù)增大及左室舒張末期內(nèi)徑增加可影響心律失常發(fā)生類型,發(fā)生室性心律失常概率更高,該差異有統(tǒng)計(jì)學(xué)意義(PO.05)。(2)血鉀水平的降低可增加心律失常發(fā)生率,但與心律失常類型無相關(guān)性(P0.05)。(3)當(dāng)血管單支病變時(shí),心律失常的發(fā)生率更高。結(jié)論:1、老年ACS患者中,合并低鉀血癥,室性心律失常發(fā)生率更高;血管病變支數(shù)、血漿BNP水平、左室射血分?jǐn)?shù)及左室舒張末期內(nèi)徑的改變不會(huì)影響心律失常發(fā)生類型。2、老年CIS患者中,血漿BNP水平升高、左室射血分?jǐn)?shù)降低及左室舒張末期內(nèi)徑增加時(shí),室性心律失常發(fā)生率更高;血管病變支數(shù)及血鉀濃度的改變對(duì)心律失常類型無明顯影響。
[Abstract]:Aim: to analyze the relationship between atrial arrhythmias and ventricular arrhythmias in elderly patients with coronary heart disease (CHD) and the number of vascular branches, plasma BNP, serum potassium concentration, left ventricular end diastolic diameter and left ventricular ejection fraction (LVEF). Methods: 634 elderly patients with coronary heart disease diagnosed by clinical symptoms and coronary angiography were all over 60 years old. According to their clinical manifestations and auxiliary examination results, they were divided into acute coronary syndrome (acute coronary syndrome,). (ACS) and chronic ischemic syndrome (chronic ischemic syndrome,CIS) group, recorded 24 hours dynamic electrocardiogram changes in each group, (Holter) identified the type of arrhythmias that occurred within 24 hours. The relationship between the incidence of atrial and ventricular arrhythmias and the number of vascular lesions, serum potassium concentration, plasma BNP, left ventricular ejection fraction and left ventricular end-diastolic diameter were further analyzed. Results: 1. The types of arrhythmias in elderly patients with acute myocardial ischemia and chronic myocardial ischemia were as follows: ACS group and CIS group: there were 476 patients in ACS group, among them, atrial preatrial contraction: 144 cases, atrial tachycardia 38 cases. There were 110 cases of atrial fibrillation 138 cases of ventricular extrasystole 34 cases of ventricular tachycardia and 12 cases of ventricular fibrillation. In CIS group, there were 18 cases of atrial precontraction, 8 cases of atrial tachycardia, 46 cases of atrial fibrillation, 62 cases of ventricular extrasystole, 22 cases of ventricular tachycardia, 2 cases of ventricular fibrillation, 2 cases of ventricular fibrillation, 22 cases of ventricular tachycardia, 2 cases of ventricular fibrillation, 46 cases of atrial fibrillation, 62 cases of ventricular extrasystole. The clinical related factors and correlation of arrhythmia type (atrial and ventricular) in elderly ACS group were as follows: (1) the concentration of serum potassium could affect the type of arrhythmias: when serum potassium was lower than normal, the incidence of ventricular arrhythmias was higher, and the incidence of ventricular arrhythmias was higher when serum potassium was lower than normal. The difference was statistically significant (67.80%, P0.05). (- 2). The incidence of arrhythmias in multi-vessel coronary artery lesions was higher than that in single-vessel lesions, but there was no significant difference (P0.05). When BNP increased, LVEF decreased and LVDD increased, the incidence of atrial arrhythmias was higher than that of ventricular arrhythmias, and there was no significant difference (P0.05). (1) the increase of plasma BNP level, the increase of left ventricular ejection fraction (LVEF) and the increase of left ventricular end diastolic diameter (LVEDD) may affect the type of arrhythmias. The incidence of ventricular arrhythmias was higher, the difference was statistically significant (PO.05). (- 2), the reduction of serum potassium level could increase the incidence of arrhythmias. However, there was no correlation between arrhythmias (P0.05). (3) and the incidence of arrhythmias was higher in single vessel lesions. Conclusion: 1. The incidence of ventricular arrhythmias is higher in elderly patients with ACS complicated with hypokalemia. The number of vascular lesions, plasma BNP level, left ventricular ejection fraction (LVEF) and left ventricular end diastolic diameter (LVEDD) did not affect the type of arrhythmias. 2. In elderly patients with CIS, the level of plasma BNP increased. When left ventricular ejection fraction decreased and left ventricular end diastolic diameter increased, the incidence of ventricular arrhythmias was higher. The number of vascular lesions and the concentration of potassium in blood had no significant effect on the type of arrhythmias.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.4;R541.7
本文編號(hào)：2449798
[Abstract]:Aim: to analyze the relationship between atrial arrhythmias and ventricular arrhythmias in elderly patients with coronary heart disease (CHD) and the number of vascular branches, plasma BNP, serum potassium concentration, left ventricular end diastolic diameter and left ventricular ejection fraction (LVEF). Methods: 634 elderly patients with coronary heart disease diagnosed by clinical symptoms and coronary angiography were all over 60 years old. According to their clinical manifestations and auxiliary examination results, they were divided into acute coronary syndrome (acute coronary syndrome,). (ACS) and chronic ischemic syndrome (chronic ischemic syndrome,CIS) group, recorded 24 hours dynamic electrocardiogram changes in each group, (Holter) identified the type of arrhythmias that occurred within 24 hours. The relationship between the incidence of atrial and ventricular arrhythmias and the number of vascular lesions, serum potassium concentration, plasma BNP, left ventricular ejection fraction and left ventricular end-diastolic diameter were further analyzed. Results: 1. The types of arrhythmias in elderly patients with acute myocardial ischemia and chronic myocardial ischemia were as follows: ACS group and CIS group: there were 476 patients in ACS group, among them, atrial preatrial contraction: 144 cases, atrial tachycardia 38 cases. There were 110 cases of atrial fibrillation 138 cases of ventricular extrasystole 34 cases of ventricular tachycardia and 12 cases of ventricular fibrillation. In CIS group, there were 18 cases of atrial precontraction, 8 cases of atrial tachycardia, 46 cases of atrial fibrillation, 62 cases of ventricular extrasystole, 22 cases of ventricular tachycardia, 2 cases of ventricular fibrillation, 2 cases of ventricular fibrillation, 22 cases of ventricular tachycardia, 2 cases of ventricular fibrillation, 46 cases of atrial fibrillation, 62 cases of ventricular extrasystole. The clinical related factors and correlation of arrhythmia type (atrial and ventricular) in elderly ACS group were as follows: (1) the concentration of serum potassium could affect the type of arrhythmias: when serum potassium was lower than normal, the incidence of ventricular arrhythmias was higher, and the incidence of ventricular arrhythmias was higher when serum potassium was lower than normal. The difference was statistically significant (67.80%, P0.05). (- 2). The incidence of arrhythmias in multi-vessel coronary artery lesions was higher than that in single-vessel lesions, but there was no significant difference (P0.05). When BNP increased, LVEF decreased and LVDD increased, the incidence of atrial arrhythmias was higher than that of ventricular arrhythmias, and there was no significant difference (P0.05). (1) the increase of plasma BNP level, the increase of left ventricular ejection fraction (LVEF) and the increase of left ventricular end diastolic diameter (LVEDD) may affect the type of arrhythmias. The incidence of ventricular arrhythmias was higher, the difference was statistically significant (PO.05). (- 2), the reduction of serum potassium level could increase the incidence of arrhythmias. However, there was no correlation between arrhythmias (P0.05). (3) and the incidence of arrhythmias was higher in single vessel lesions. Conclusion: 1. The incidence of ventricular arrhythmias is higher in elderly patients with ACS complicated with hypokalemia. The number of vascular lesions, plasma BNP level, left ventricular ejection fraction (LVEF) and left ventricular end diastolic diameter (LVEDD) did not affect the type of arrhythmias. 2. In elderly patients with CIS, the level of plasma BNP increased. When left ventricular ejection fraction decreased and left ventricular end diastolic diameter increased, the incidence of ventricular arrhythmias was higher. The number of vascular lesions and the concentration of potassium in blood had no significant effect on the type of arrhythmias.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.4;R541.7
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