急性心肌梗死溶栓后早期T波变化的临床意义

Clinical study on the early changes of T wave after thrombolitic therapy in patients with acute myocardial infarction

目的利用动态心电图观察急性心肌梗死溶栓后早期T波变化的临床意义。方法选择急性心肌梗死行溶栓治疗患者105例,记录心电监测/或动态心电图T波倒置的时间,依据溶栓后T波倒置的时间分为A组(24 h内倒置者)、B组(24 h后倒置者),然后依据冠脉造影及临床间接血管再通标准,观察T波倒置的时间与冠脉再通的关系。结果(1)A组与梗死相关、动脉高开通率密切相关(91.2%与55.5%,P<0.05)。(2)早期T波倒置者磷酸肌酸激酶同功酶(CK-MB)峰值较低〔(114±21)与(165±31)U/L,P<0.05)〕。(3)T波早期倒置者住院期间左室射血分数不断提高〔(59±13)%与(43±15)%,P<0.05)〕。(4)T波早期倒置者住院期间冠脉事件的发生率低(8.3%与29.6%,P<0.05)。结论心肌梗死溶栓后早期T波倒置与冠脉再通密切相关,预示更好的再灌注和左室功能及良好的临床预后。

Objective To investigate the significance ofearly change of T wave after thrombolitic therapy in patients with acute myocardial infarction, Methods 105 patients with acute myocardial infarction who received thrombolitic therapy were analyzed restmspectively. Patients strati fication was based on the presence or absence of early （within 24 hour）T wave inversion. The relation between T wave inversion and recanalization of coronary artery according to angiographic and clinical reperfusion standard. Results （ 1 ） Early T Wave inversion was associated wish a higher recanalization rate of coronary artery （91.2 % vs 55.5 %, P 〈 0.05）. （2） The maximum creatinc kinase levels were lower in Early T wave inversion group. （3）Early T wave inversion was accompanied by better myocardial preservation as reflected by substantial improvement of left ventricular ejection fraction during hospitalization. （4）Early T wave inversion anticipated a more benign development during hospitalization with a low incidence of adverse cardiac events. Conclusion Early inversion of T wave in patients with recanalization of coronary artery, which may suggest a better reperfusion and left ventricle function, with a better clinical prognosis.