急性心肌梗死患者冠脉急诊介入术后ST段回落的研究

A study of the ST-segment resolution of acute myocardial infarction patients treated with emergent percutaneous coronary intervention

目的通过12导联动态心电图观察急性心肌梗死(AMl)患者急诊冠脉介入术(PCI)后24h内心电图ST段的回落,探讨ST段不同程度的回落对预后的影响。方法62例ST段抬高急性心梗(STEMl)患者,发病12h内进行急诊冠脉介入术治疗,术后梗死相关血管血流达TIMl3级,分析其12导联动态心电图中ST段的回落程度,结果分成ST段回落组(ST段回落>50%)及ST段无回落组(ST段回落<50%)。平均随访半年,比较二组的临床事件及预后。结果本组ST段回落主要发生于术后120min内,其中发病至冠脉介入术的时间、再灌注时间以及发病至CK-MB达峰值时间在ST段回落组均短,与ST段无回落组相比有显著性差异。进一步分析显示,该组患者住院期间的总心脏事件发生率低于ST段无回落组,半年死亡率低于ST段无回落组。结论急性心梗发病至心肌再灌注的间期对ST段的充分回落十分重要,ST段早期及充分回落患者近远期预后良好。

Objective Using 12 lead Hoher to observed the resolution of ST-segment in acute myocardial infarction （AMI） patients who received percutaneous coronary intervention （PCI） treatment,and discuss the prognostic value of ST-segment resolution. Methods 62 STEAMI patients received PCI within 12h of onset,whose infarct related artery reached TIMI grade 3. They were divided into two groups according to ST-segment resolution：ST-segment resolution group （ST-segment resolution≥50% ） and unchanged ST-segment group （ST-segment resolution〈50%）. All the patients were followed-up for six months. Results ST-segment resolution occurred mainly at 120 min after emergent PCI. The duration from chest pain to receiving PCI,and the peak time of CK-MB were shorter in the ST-segment resolution group which was significant different from ST-segment unchanged group. The incidence of total cardiac events in hospital and the death rate of half a year was lower in ST-segment resolution group. Conclusion The duration from chest pain to receiving PCI was crucial important to ST-segment complete resolution. The patients of early and complete resolution of ST-segment were a good short and long term prognosis.