ST段抬高型急性心肌梗死不同方法治疗前后心电图指标变化的观察

ECG changes before and after various modalities of treatments for ST-elevated acute myocardial infarction

目的通过对ST段抬高型急性心肌梗死各种方法治疗前后心电图指标的观察,对比各种治疗方法是否有效及疗效是否存在差异。方法将入选病例分为六组:非再灌注治疗再通组(A1组)、非再灌注治疗未再通组(A2组)、溶栓治疗再通组(B1组)、溶栓治疗未再通组(B2组)、直接经皮冠状动脉介入治疗(PCI)组(C组)、溶栓+补救性PCI治疗组(D组)。分别测量各组治疗前后心电图ST段抬高导联ST段抬高的总和(∑ST)及最长QT间期(QTmax)、最短QT间期(QTmin)。结果治疗前与治疗后ST段抬高的总和及校正的QT间期离散度(QTcd)的差异均有显著性,QT间期离散度(QTd)在B1、C、D组差异有显著性;ST段抬高总和的下降幅度在A1与A2组、B1与B2组差异有显著性;四个再通组ST段抬高总和的下降幅度和QTcd的下降幅度之间差异无显著性,而QTd下降幅度差异有显著性。结论①ST段恢复及QT间期离散度可以作为预测急性心肌梗死再灌注治疗成功的敏感指标。②各种再灌注治疗均可降低ST段抬高及QT间期离散度,即恢复心肌组织和细胞水平再灌注及心室肌复极均一性。③非再灌注治疗与再灌注治疗对急性心肌梗死的疗效存在差异,但不同再灌注治疗方法之间尚无依据证明存在差异。

Objective By observing the ECG changes before and after various modalities of treatments for ST--elevated acute myocardial infarction （STEMI） to demonstrate the effect of these treatments and compare the effect between these treatments. Methods 62 patient with STEMI were divided into 6 groups： recanalization group of non-- reperfusion therapy（ A1 ）, no recanalization group of non--reperfusion therapy（ A2 ）, recanalization group of thrombolytic therapy（ Be ）, no recanalization group of thrombolytic therapy（ Be ）, direct PCI therapy group （C ）, thrombolytic therapy added by rescue PCI therapy grou（D）. Measuring the sum of ST segment resolution, the maximum of QT interval and the minimum of QT interval. Results Between before and after the treatment, there is significant difference for the ∑ST segment and QTcd in all groups, and for QTd in B1, C, D groups; there is significant difference for extent of the ∑ST segment resolution between A1 and A2, also B1 and B2 ; there is significant difference for extent of the QTd resolution in A1,B1, C, D groups. Conclusions All of the reperfusion therapies can decrease the elevation of ST segment and prolongation of QT dispersion, assuming reperfusion of myocardial tissue and cellular level and repolarization uniformity of ventricular myocardium. There is significant difference between non--reperfusion therapy and reperfusion therapy for acute myocardial infarction, but there is no evidence to demonstrate the difference between various reperfusion therapy.