急性心肌梗死介入治疗后心电图ST-T改变的临床意义

Clinical significance of electrocardiogram ST-T changes after PCI in patients with acute myocardial infarction

目的探讨急性心肌梗死(AMI)介入治疗后心电图ST-T改变在评估左心功能和临床预后中的临床意义。方法观察87例ST段抬高并接受急诊经皮冠状动脉介入(PCI)治疗的AMI患者,根据PCI治疗后ST-T段演变分为ST-T改变组(A组)和无ST-T改变组(B组)。根据发病后行PCI的时间分为≤6 h组和≤12 h组,观察心电图ST-T改变情况。结果 PCI≤6 h组和≤12 h组患者ST段回落指数均>50%,≤6 h组回落程度显著优于≤12 h组(P<0.01)。A组患者PCI术后情况稳定,心功能情况较好;B组心功能情况较差,临床表现为多发性反复发作左心衰竭。A组患者随访第1个月和第6个月的左心室射血分数及左心室舒张末期内径明显优于B组。A组再发性心血管事件发生率为6.56%,明显低于B组的34.62%(P<0.05)。结论通过监测急性心肌梗死介入治疗后心电图ST-T变化情况,可以更好地评价血管再通后心肌再灌注的效果,对评估AMI患者PCI术后心脏功能和临床预后情况均具有重要的临床意义。

Objective To study the clinical significance of electrocardiogram ST-T changes in the assessment of left heart function and clinical prognosis after perentaneous coronary intervention （PCI） in patients with acute myocardial infarction （AMI）. Methods 87 patients with acute ST segment elevation myocardial infarction after successful primary PCI were studied. They were divided into ST-T changes group （group A） and the non ST-T changes group （group B） according to the ST-T evolution after the PCI treatment. All patients were divided into ≤6 h group and ≤ 12 h group by the time of adopting PCI. Then the result of electrocardiogram ST-T changes was observed. Results The ST-segment elevation resolution of ≤6 h and ≤ 12 h group was 〉 50%. The ≤6 h group was better than ≤ 12h group. The cardiac function of group A were better after treatment than group B. The LVEF and LVDD of group A were much better than the group B in 1 and 6 months. The incidence of cardiovascular events was 6.65% in group A. The incidence of group B was 34.62%. They had a significant difference （P〈0.05）. Conclusion The ST-T change was used to evaluate the effect of myocardial reperfusion after recanalization. It had important clinical significance in evaluating the cardiac fimction and clinical prognosis of patients with AMI after PCI.