急性心肌梗死静脉溶栓治疗后ST段再抬高临床意义探讨

Study on the Clinical Significance of Re-elevation of ST Segment After Intravenous Thrombolysis in Acute Myocardial Infarction

目的：探讨急性心肌梗死（AMI）静脉溶栓治疗中ST段再抬高产生的原因及临床意义。方法：回顾性分析符合静脉溶栓标准的121例AMI患者的临床资料,据溶栓后有无ST段再抬高而分为ST段抬高组（A组）和ST段未抬高组（B组）,比较两组间血管再通率、心律失常发生率、CK峰值水平、梗死后心绞痛、猝死发生率及心功能变化、冠脉造影结果。结果：A、B两组患者各项指标均有显著性差异（P〈0.05）。A组血管再通率明显低于B组（P〈0.05）;梗死后心律失常发生率、心绞痛发生率、猝死率及心功能不全发生率均高于B组（P〈0.05）;A组伴发代谢综合征明显多于B组（P〈0.05）。结论：静脉溶栓治疗时ST段再抬高与患者合并代谢综合征有密切关系。在溶栓后1-2h内出现ST段下降后再抬高或原有梗死相关部位ST段抬高再加重,其原因可能与溶栓后再灌注损伤及冠脉痉挛有关,其它部位ST段抬高,可能与溶栓后纤溶激活状态致冠脉痉挛或闭塞有关。而在24h后出现ST段再抬高可能与新的血栓形成引起再闭塞或梗死延展有关。

Objective： To study the cause and clinical significance of re- elevation of ST segment after intravenous thrombolysis in acute myocardial infarction. Methods： Clinical data of 121 acute myocardial infarction patients who complied with the standard of intravenous thromblysis treatment were retrospectively analyzed. According to whether the ST segment was re- elevated or not, patients were grouped into group A （with ST segment elevation） and group B （without ST segment elevation）. Rate of patency of the coronary artery, incidence of arrhythmia, peak level of CK, angina pectoris after infarction, mortality due to sudden death, cardiac function, result of coronary contrast imaging were compared between these two groups. Results： Significant difference existed in all the parameters between group A and B （P〈 0.05）. Rate of patency of the coronary artery was significantly lower in group A （P 〈 0.05） ; incidence of arrhythmia, peak level of CK, angina pectoris after infarction, mortality due to sudden death, incidence of cardiac dysfunction were higher in group A （P 〈 0.05）; More patients in group A were complicated with metabolism syndrome （P 〈 0.05）. Conclusions： There is close relationship between the phenomenon of re - elevation of ST segment in the treatment of intravenous thromboly- sis and the metabolism syndrome. The cause of re - elevation of ST segment or aggravation of ST elevation 1 2 hour after thrombolysis may be reperfusion injury or spasm of the coronary artery. Elevation of ST segment of other location may be because of spasm or obliteration of the coronary artery owing to the fibrolysis state after thrombolysis. However, re-elevation of ST segment after 24 hours may be because of re - occlusion or extension of infarction due to new thrombus.