急性心肌梗死再灌注后心电图ST段抬高的意义

The clinical importance of persistent elevation of electrocardiographic ST segment in acute myocardial infarction patients after reperfusion therapy

目的 探讨急性心肌梗死 (AMI)患者接受经皮冠状动脉腔内成形术 (PTCA)治疗后心电图ST段持续抬高与临床预后的关系。方法 AMI患者共 30例 ,比较PTCA前及术后 1h 12导联心电图抬高ST段的总和 ,按ST段下降幅度分为两组 ,A组 :ST段下降≥ 5 0 % ,B组 :ST段下降 <5 0 %。行小剂量多巴酚丁胺负荷超声心动图检查并随访复查超声心动图。结果 AMI发病早期基础状态和负荷状态及发病后第 1、2、3个月左室射血分数 (LVEF)A组均明显大于B组。多巴酚丁胺负荷状态下主动脉峰值血流加速度、每搏输出量及每搏指数A组明显大于B组。基础状态和负荷状态下总室壁运动积分指数 (GWMSI)和梗死区室壁运动积分指数 (IWMSI)A组均明显小于B组。AMI发病后 1、2、3个月GWMSIA组均明显小于B组。发病第 1、2个月IWMSI两组间差异无统计学意义。发病第 3个月IWMSIA组明显小于B组。结论 AMI直接PTCA后心电图ST段持续抬高的患者左室收缩功能及收缩储备功能以及梗死区室壁运动的恢复明显低于ST段迅速下降者。

Objective To observe the clinical importance of persistent elevation of electrocardiographic ST segment in acute myocardial infarction(AMI) patients receiving direct percutaneous transluminal coronary angioplasty (PTCA).Methods Thirty patients with a first AMI successfully treated with direct coronary angioplasty were selected. The extent of the ST segment elevation and resolution in electrocardiograms on admission and one hour after direct PTCA was analyzed. All the patients were divided into two groups according to the extent of ST segment elevation and resolution. Group A: resolution of ST segment elevation ≥50%, n =19; Group B: resolution of ST segments elevation < 50%, n =11. Low dose dobutamine stress echocardiogram was taken at (7±2) days after AMI and echocardiogram checked at 1,2 and 3 months after AMI.Results Left ventricular ejection fraction (LVEF) in group A was higher than that in group B at the first week and the first, second and third month after AMI. Aortic blood peak acceleration,cardiac output and cardiac output index of group A were all significantly higher than those in group B at stress. Global wall motion score index (GWMSI) and infarct zone wall motion score index (IWMSI) in group A were smaller than those in group B at baseline and stress. GWMSI in group A was smaller than that in group B at 1, 2 and 3 months after AMI. There was no significant difference of IWMSI between group A and group B at 1 and 2 months after AMI. IWMSI in group A was smaller than that in group B at the third month after AMI. Conclusions The patients in group B had lower left ventricualr contractile function and contractile reserve function and less recovery of infarct zone wall motion than that in group A.