急性心肌梗塞后心肌缺血、缺血性室性心律失常的发作特点及其对预后预测价值的研究

Clinical features and prognostic value of ischemia and ischemic arrhythmias after acute myocardial infarction

为探讨急性心肌梗塞（ＡＭＩ）后心肌缺血和缺血性心律失常（ＩＳＡ）的发作特点及其对预后的预测价值，对７４例ＡＭＩ病人应用心电监护系统在发病后１～５ｄ和２１～２５ｄ进行了连续心电监测和１年的随访．结果表明，ＡＭＩ后心肌缺血和ＩＳＡ的发生规律基本吻合，于发病后７２ｈ内显著减少．２１例（２８．４％）在随访期间发生心脏事件．相关分析证实，ＡＭＩ后ＩＳＡ为发生心脏事件的一良好的预测指标．ＡＭＩ后２～３ｄＳＴ段的变化与心脏事件的相关性显著地高于５ｄ和２１～２５ｄ．提示发病后２～３ｄ进行心电监护所获得的结果对病人预后的预测价值最大．

The aim of the study was to analize the characteristics and prognostic significance of ischemia and ischemic arrhythmias after AMI.74 patients of acute myocardial infarction(AMI )were continuously studied with electrocardiographic monitoring system at 1～5and 21～25 days after AMI, The results showed that 32.4%of the patients had myocadiai ischemic episodes. The total time of ischemia per 24 hours was remarkably reduced with in the 72 hours after the onset of AMI.The ratio of patients who had ischemic arrhythmias (ISA) was 12.1%, 21 patients (28.4%)had heart events during the follow-up period. The results of the relative analysis showed that both myocardial ischemia and ISA was a very spectific predictive factor. The prognostic significance of the ischemia during the 2～3 days after AMI was significantly higher than that of the 5th and 21～25 days after AMI.Thus the results of electrocardiographic monitoring during 2～3 days after AMI had higher prognostic significance.