急性心肌梗死患者冠状动脉Gensini积分与血钾水平的相关性

Association of serum potassium level with infarct area and coronary Gensini score in patients with acute myocardial infarction

目的 探讨ST段抬高型急性心肌梗死（acute ST segment elevation myocardial infarction,STEMI）患者心肌梗死面积、冠状动脉Gensini积分与血钾水平的关系,指导治疗方案,制定临床决策,改善患者预后。方法 选择行急诊经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）STEMI的患者128例,按照入院血清钾水平分为低于3.50mmol/L、高于3.50mmol/L两组,监测其18导联心电图并记录PCI冠状动脉病变结果,前壁根据Aldrich公式,下壁根据Clemmensen改良公式计算心肌梗死面积,运用Gensini积分评价冠状动脉病变程度,同时记录患者住院期间心血管不良事件的发生情况。结果 入选的128例STEMI患者中,低血钾发生率为29.7%（38/128）,其中广泛前壁STEMI发生率最高42.1%（16/38）,下壁累及后壁STEMI发生率最低5.3%（2/38）;低钾组梗死面积小于20%者14例,20%-30%者14例,大于30%者10例,低钾组梗死面积明显高于血钾正常组,差异有统计学意义（P〈0.01）;低钾组冠状动脉Gensini积分小于50分者6例,50-80分者12例,大于80分者20例,低钾组冠状动脉Gensini积分明显高于血钾正常组,差异有统计学意义（P〈0.05）。血钾浓度与梗死面积、Gensini积分呈负相关（P〈0.01）。结论STEMI患者中低钾血症发生与梗死面积、部位密切相关,多为前降支、近段病变.且梗死面积越大、冠状动脉病变程度越重越易出现低钾血症。将血钾控制在适当水平有助于预防并发症的发生,并能改善预后。

Objective To evaluate the relationship between the serum potassium level and the myocardial infarction area and coronary Gensini scores in patients with acute ST segment elevation myocardial infarction （STEMI）, so as to guide the treatment, make clinical decisions and improve the prognosis of the patients. Methods A total of 128 patients with STEMI receiving primary percutaneous coronary intervention （PCI） in our hospital were enrolled in this study. According to the serum potassium level, the patients were divided into hypokalemia group （serum potassium 43.5 retool/L） and normal potassium group （serum potassium -3.5 mmol/L）. The 18 leading electrocardiogram （ECG） was carried out on each patient and the PCI results of each patient were recorded. Myocardial infarction area was calculated basing on the Aldrich and Clemmensen formula and Gensini scoring was used to evaluate the severity of coronary artery lesions. The adverse events of the patients were also recorded. Results The incidence of hypokalemia was 29.70/oo （38/128）, among which the extensive anterior wall STEMI had the highest incidence 42.1 % （16/38） , and the inferior wall STEMI had the lowest incidence 5.3 % （2/38）. In the h ypokalemia group, there were 14 patients with myocardial infarct area （MIA） less than 20%, 14 patients with MIA between 200% and 30% and 10 patients with MIA more than 30%, significantly higher than the MIA in normal potassium group （ P 〈0.01）. In hypokalemia group, 6 patients were with Gensini score lower than 50, 12 patients with Gensini score between 50 and 80, and 20 with Gensini score more than 80, also remarkably higher than that in the normal group （ P〈0.05）. Pearson correlation analysis showed that there were negative correlation between serum potassium, infarction area and Gensini scores （ P 〈0.01）. Conclusion The incidence of hypokalemia in STEMI patients is closely related to the infarction area and the infarction position, especially the infarction in anterior descending and proximal coronary artery. Thus, appropriate control of the potassium levels can be helpful for reducing the occurrence of complications and improving the prognosis of the patients.