急性ST段抬高性心肌梗死直接经皮穿刺冠状动脉成形术后早期ST段变化的意义

Clinical implication of early ST segment changes after primary percutaneous coronary intervention for acute ST segment elevation myocardial infarction

目的 探讨急性ST段抬高性心肌梗死（STEMI）直接经皮穿刺冠状动脉成形术（PCI）术后梗死相关动脉（IRA）完全开通、前向血流恢复后，早期ST段变化的临床意义。方法回顾性分析2001-01-12北京朝阳医院心脏中心收治的216例直接PCI后、IRA完全开通、前向血流恢复正常病人的临床、冠脉造影和心电图资料。直接PCI术后，ST段抬高指数≥50％的病人41例，为病例组。从其余175例ST段抬高指数〈50％的病人中随机抽取50例，为对照组。结果两组病人的ST段抬高指数、Q波计数、室壁运动积分和平均肌酸激酶值差异有显著性意义（P〈0．05）；术后2周，ST段早期恢复较ST段持续抬高病人的室壁运动改善，左室射血分数（LVEF）、心排指数（CI）、每搏指数（SVI）增加（P〈0．05）。ST段早期恢复合并心功能不全的病人，术后2周室壁运动增强，INEF、CI、SVI增加（P〈0．05），左室舒张末容积、左室收缩末容积减少（P〈0．01）。结论STEMI直接PCI后IRA完全开通、前向血流恢复正常而ST段持续抬高病人的梗死范围扩大．左室舒缩功能不全严重．可能与心肌组织没有有效地恢复血流灌注或无复流有关。

Objective To elucidate the clinical implication of early ST segment changes after PCI for IRA for acute ST segments elevation myocardial infarction. Methods From Jan. 2001 to Dec. 2001, 216 patients with AMI after successful angiographical primary PCI Who were admitted to Beijing Chaoyang Hospital were retrospectively analysed. Forty-one patients with index of ST segment elevation ≥50% and 50 randomised patients from 175 patients with index of ST segment elevation 〈 50% were studied. Results There are significant difference in index of ST segment elevation, the number of Q waves on electrocardiogram, and WMS and average value of creatine kinase in two groups （ P〈0.05 ） . WMS, LVEF, CI, SVI improved in patients of early resolution of ST segment elevation （ P 〈 0.05） . WMS, LVEF, CI, SVI improved （ P〈0. 05 ）, while LVEDV and LVESV decreased in patients of early resolution of ST segment elevation 2 weeks after procedure （ P 〈 0.01 ） . Conclusion The patients with persistent ST elevation after successful angiographical primary PCI have larger area of necrotic and jeopardized myoeardium, and deteriorate left ventricular dysfunction. It＇s probably because of substantial microvascular damage or no-reflow in reperfusion.