ST段抬高型心肌梗死患者血运重建手术后ST段回复的相关因素研究

Related factors of ST-segment resolution in patients with acute ST-segment elevation myocardial infarction after revascularization operation

目的探讨ST段抬高型心肌梗死患者接受急诊经皮冠状动脉介入治疗（PCI）术后ST段回复不良的影响因素。方法选取接受急诊PCI的ST段抬高型心肌梗死患者186例，根据术后ST段回复程度分为ST段回复不良组（54例）和ST段回复良好组（132例）。比较两组的临床资料，单因素及Logistic多因素回归分析患者术后ST段回复不良的影响因素。结果梗死前心绞痛是患者术后ST段回复不良的保护因素（OR=0．361，95％CI 0．131～0．994，P〈0．05），前壁心肌梗死、发病至球囊扩张时间、心功能Killip分级、入院白细胞是患者术后ST段回复不良的危险因素（OR=2．389，95％CI 1．194～4．781；OR=1．655，95％CI 1．082～2．532；OR=1．319，95％CI 1．026—1．695；OR=1．184，95％CI 1．004～1．396，P〈0．05）。结论梗死前发生心绞痛的患者术后发生sT段回复不良的风险降低，而前壁心肌梗死、发病至球囊扩张时间较长、心功能Killip分级≥2级、入院白细胞增高的患者术后发生ST段回复不良的风险增高，对此应该采取更早更积极的临床干预措施。

Objective To observe the factors affecting inadequate ST-segment resolution in patients with acute ST-segment elevation myocardial infarction after emergency percutaueous coronary intervention （PCI）. Methods The patients with acute ST-segment elevation myocardial infarction undergoing emergency PCI were enrolled for study. According to the ratio of ST-segment resolution, 186 cases were divided into inadequate ST-segment resolution group （54 cases） and relatively adequate ST-segment resolution （132 cases）. Clinical data of two groups were compared. The single factor and multiple Logistic regression analysis were performed to determine the factors influencing inadequate ST-segment resolution. Results Pre-infarction angina was protective factor of inadequate ST-segment resolution after emergency PCI （OR = 0.361, 95% CI 0.131 - 0.994, P 〈 0.05）. Anterior myocardial infarction, attack-to-balloon time, Killip classification and white blood cell counts were risk factors of inadequate ST-segment resolution （OR = 2.389, 95% CI 1.194 - 4.781; OR = 1.655, 95% CI 1.082 - 2.532; OR = 1.319, 95% CI 1.026 - 1.695; OR = 1.184, 95% CI 1.004 - 1.396, P 〈 0.05）. Conclusions Patients with pre-infarction angina could reduce the risk of inadequate ST- segment resolution after PCL Patients with anterior myocardial infarction,long attack-to-balloon time, Killip classification ≥ 2 and high blood cell counts could increase the risk of inadequate ST-segment resolution, and earlier and more active clinical intervention should be taken.