ST段抬高心肌梗死患者急诊PCI术后心肌再灌注的预测指标

Predictive index of myocardial reperfusion in patients with ST-segment elevation myocardial infarction undergoing primary PCI

目的评价ST段抬高心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者急诊冠脉介入(percutaneous coronary intervention,PCI)术后心肌再灌注的预测指标。方法选择发病12 h内接受直接PCI治疗的STEMI患者176例,根据术后TIMI血流分级分为A组(TIMI 3级,灌注良好组),B组(TIMI 0-2级,灌注不良组)。采用心电图ST段回落、心肌损伤标志物水平进行分析。结果灌注不良组患者心电图ST段术后1 h回落不佳;CK-MB水平B组明显高于A组(P<0.01),且峰值持续时间长;术后BNP水平B组明显高于A组(P<0.05);术后1周B组LVEF值明显低于A组(P<0.05)。结论 ST段早期回落是STEMI患者急诊PCI术后心肌再灌注的有效预测指标,与心肌损伤标志物水平升高一致。

Objective ToevaluatethepredictiveindexofmyocardialreflowinpatientswithST-segment elevation myocardial infarction （STEMI ） undergoing percutaneous coronary intervention （PCI）.Methods Onehundredandseventy-sixSTEMIpatientswereenrolledwhohadundergone PCI treatment within 1 2 hours since STEMI attacked.According to postoperative TIMI blood flow clas-sification,they were divided into group A （TIMI at level 3,perfusion group）and group B （TIMI at level 0-2,hypoperfusion group）.The results were analyzed by the fall of ST-segment on ECG and thelevelofmyocardialinjurymarkers.Results ForpatientsingroupB,ST-segmentfellinsufficient-ly one hour after PCI.The level of CK-MB in group B was significantly higher than that in group A （P〈0.01 ）and the duration of peak value of CK-MB in group B was longer.The level of postoperative BNP in group B was significantly higher than that in group A （P〈0.05 ）.One week after PCI,the valueofLVEFwassignificantlyloweringroupBthanthatingroupA（P〈0.05）.Conclusion Ear-ly ST-segment fall proves to be an effective predictor of myocardial reperfusion in STEMI patients un-dergoing primary PCI,which is consistent with the increase of the level of myocardial injury markers.