急性心肌梗死时梗死对应区导联ST段下移与冠脉病变的关系及PTCA后的演变

The relationship between reciprocal ST segment depression and pathological changes of coronary arteries in AMI and outcome after PTCA

目的 观察急性心肌梗死（ＡＭＩ）患者梗死对应区导联ＳＴ段下移（Ｒ－ ＳＴ－ Ｄ） 与冠状动脉病变的关系。方法 对４０ 例初发单部位ＡＭＩ患者于梗死后２～８ ｈ 内作冠状动脉腔内成形术（ＰＴＣＡ），并描记手术前后心电图，观察手术所见冠脉病变与Ｒ－ ＳＴ－ Ｄ的关系、梗死区导联ＳＴ段偏移程度与Ｒ－ ＳＴ－ Ｄ的关系及ＰＴＣＡ后ＳＴ段演变。结果 本组病例多支血管病变者占５７－５％ （２３／４０），其Ｒ－ ＳＴ－ Ｄ 阳性者７３－９％（１７／２３） ，显著高于单支病变者（Ｐ＜ ０．００５） ；Ｒ－ ＳＴ－ Ｄ阳性者中７６－２％ （１６／２１）有梗死对应区供血冠脉明显狭窄；Ｒ－ ＳＴ－ Ｄ阳性与阴性组梗死区导联ＳＴ段最大抬高值分别为（３－８±１－７） ｍｍ 和（４－４ ±１．９） ｍｍ ，组间无显著性差异（ｔ＝１－１４９ ，Ｐ＞ ０－０５） ；ＰＴＣＡ后梗死区导联抬高的ＳＴ段明显下降但多不能完全回复至基线，Ｒ－ ＳＴ－ Ｄ 都基本恢复正常。结论 多数Ｒ－ ＳＴ－ Ｄ可用梗死对应区供血冠脉病变解释其发生，但也有梗死对应区供血冠脉正常而发生Ｒ－ ＳＴ－ Ｄ者，故Ｒ－ ＳＴ－ Ｄ的发生机理尚待进一步探索。

Objective To assess the relationship between reciprocal ST segment depression(R-ST-D) and pathalogical changes of coronary arteries in acute myo cardial infarction(AMI).Methods PTCAs were performed during 2 to 8 hours after attacking of AMI in 40 patients with first single-focus AMI. Pre-and post-PTCA electrocardiograms were recorded. The relationships among the pathalogical changes of corolary arteries, the extent of ST segment elevation in the leads relating infarcted sites, and R-ST-D were analysed. The ST segment changes after PTCA were observed.Results the occurrence of multi-vessel disease was 57.5%(23/40) in is group and the positive rate of R-ST-D in the patients with multi-vessel disease was significantly higher than in patients with single-vessel disease (73.9% vs 23 5%, P <0 005); serious stenosis of coronary arteries relating reciprocal area of infarcted sites were found in 76.2%(16/21) cases of positive R-ST-D; the maximal values of ST elevation in the leads relating infacted sites were (3.8±1.7) mm and (4.4±1.9) mm seperately in positve and negetive R-ST-D groups, there was no significant defference between the groups ( t=1 149,P>0.05) ; the ST elevation of the leads relating infarcted sites singnificantly decreased, but didn't become normal, the R-ST-Ds disappeared after PTCA.Conclusions The most of R-ST-D could be explanded by coronary stenosis of reciprocal area of infarcted site, but normal coronary atery in the reciprocal area was also found in some cases of positive R-ST-D. So the mechnism of R-ST-D have yet to be studied.