缺血分级对ST段抬高急性心急梗死患者心律失常的影响

Predictive significance of ischemia classification for arrhythmia in patients with ST-segment elevation acute myocardial infarction

目的探讨ST段抬高急性心急梗死(STEMI)患者心肌缺血分级对患者心律失常的影响。方法选取2009年6月～2011年5月未行溶栓治疗的STEMI患者76例,按心电图缺血分级分为Ⅱ级缺血组(36例)与Ⅲ级缺血组(40例)。比较两组患者入院时及溶栓2 h后心电图ST段的变化,统计并比较室性早搏、室性心动过速或室颤、窦性停博及Ⅱ度或Ⅲ度房室传导阻滞等严重心律失常的发生率。结果患者入院时,Ⅱ级缺血组ST段抬高程度[(0.45±0.26)mV]明显低于Ⅲ级缺血组[(0.81±0.33)mV],差异有统计学意义(t=5.242,P<0.05);Ⅲ级缺血组肌酸激酶同工酶(CK-MB)峰值[(370±67)U/L]高于Ⅱ级缺血组[(215±61)U/L],差异有统计学意义(t=9.343,P<0.05)。溶栓治疗2 h后,Ⅱ级缺血组ST段抬高程度[(0.23±0.11)mV]、ST段回降一半及以上比例[80.6%(29/36)]、CK-MB峰值[(227±58)U/L]均优于Ⅲ级缺血组[(0.49±0.17)mV、57.5%(23/40)、(358±94)U/L],差异有统计学意义(P<0.05)。Ⅱ级缺血组与Ⅲ级缺血组在室性早搏[8.3%(3/36)、12.5%(5/40)]、室性心动过速或室颤[2.8%(1/36)、7.5%(3/40)]、窦性停博[0.0(0/36)、2.5%(1/40)]及Ⅱ度或Ⅲ度房室传导阻滞[2.8%(1/36)、5.0%(5/40)]等严重心律失常的发生率比较,均无统计学意义(P>0.05)。Logistic回归分析结果显示,入院时心电图ST段抬高程度、发病至溶栓时间及Ⅲ级缺血是STEMI患者发生严重心律失常的独立危险因素(P<0.05)。结论缺血分级对ST段抬高急性心急梗死患者心律失常具有预测价值。

Objective To investigate the influence of ischemia classification for arrhythmia in patients with ST-segment elevation acute myocardial infarction （STEMI）. Methods 76 cases of STEMI patients from June 2009 to May 2011 were selected and divided into grade Ⅱ ischemia group （36 cases） and grade m ischemia group （40 cases） through the ischemic electrocardiographic grade. ECG ST-segment changes were compared on admission and 2 hours after the thrombolysis in the two groups. The incidence of serious arrhythmias including premature ventricualr contraction, ventricular tachycardia or ventricular fibrillation, sinus arrest and Ⅱ or m degree atrioventricular block were recorded and compared. Results The degree of ST-segment elevation in grade 11 ischemia group [（0.45±0.26） mV] was lower than that in grade 11[ ischemia group [（0.81±0.33） mV] when patients admitted to hospital, the difference was statistically significant （t = 5.242, P 〈 0.05）; peak value of CK-MB in Ⅲ ischemia group [（370±67） U/L] was higher than that in I1 ischemia group [（215±61） U/L] when patients admitted to hospital, the difference was statistical- ly significant （t = 9.343, P 〈 0.05）. The degree of ST-segment elevation, ST segment proportion of falling back half or more, peak value of CK-MB in grade I1 ischemia group 2 hours after the thrombolysis [（0.23±0.11） mV, 80.6% （29/ 36）, （227±58） U/L] wei＇e all better than those in grade HI ischemia group [（0.49±0.17） mV, 57.5% （23/40）, （358±94） U/L], the differences were statistically significant （P 〈 0.05）. The differences of incidence of premature ventricualr con- traction [8.3%（3/36）, 12.5%（5/40）], ventricular taehycardia or ventricular fibrillation [2.8%（1/36）, 7.5%（3/40）], sinus arrest [0.0（0/36）, 2.5%（1/40）] and Ⅱ or m degree atrioventrieular block [2.8%（1/36）, 5.0%（5/40）] were not statistically significant （P 〉 0.05）. The degree of ST-segment elevation, the time from disease to thrombolysis, grade Ⅲischemia were the independent risk factors of severe anhythmia according to the Logistic regression analysis （P 〈 0.051）. Conthtsion Lschemic grade has predictive value in patients with ST-segment elevation acute myocardial intaretion and at-rhythmia.