急性心肌梗死患者经皮冠状动脉介入治疗后心电图ST段回落与其预后的相关性分析

Analysis on the relationship between the decline of ST segment of electrocardiogram and prognosis in AMI patients after PCI treatment

目的研究急性心肌梗死（AMI）患者经皮冠状动脉介入治疗（PCI）后心电图sT段的回落情况与其预后的相关性。方法选取2016年6月至2017年6月在医院进行治疗的急性心肌梗死患者200例作为研究对象。根据其治疗后的心电图情况将患者分为两组，每组100例。其中A组患者治疗后2h心电图sT段抬高总和下降I〉50％，B组患者治疗2h后心电图sT段抬高总和下降〈50％。观察两组患者心脏不良事件发生率，TIMI血流分级，FVEF以及分析严重不良心脏事件发生的影响因素。结果A组患者患糖尿病比例高于B组，且发病至梗死相关动脉（IRA）再通时间短于B组，差异有统计学意义（P〈0．05）。A组术后IRA血流情况≤TIMI2级例数少于B组，但差异未见统计学意义（P〉0．05）。A组患者左心室射血分数（LVEF）高于B组，心脏不良事件发生率（7％）低于B组（25％），差异有统计学意义（P〈0．05）。单因素分析发现糖尿病、胸痛症状到开始再灌注时间以及梗死前心绞痛均是导致心脏不良事件的可能危险因素；治疗后2h心电图sT段抬高总和、是否存在糖尿病和发病至IRA再通时间为导致心脏不良事件发生的独立危险因素（P〈0．05）。结论急性心肌梗死患者在接受PCI治疗后，其心电图ST段的早期改变对于患者的近期预后有十分重要的预示作用，就心肌再灌注情况而言，心电图sT段的下降可能比TIMI血流分级起到更加明显的预示作用。

Objective To study the relationship between the decline of ST segment of electrocardiogram and prognosis in acute myocardial infarction （AMI） patients after percutaneous coronary intervention （PCI） treatment. Methods Two hundred patients with acute myocardial infarction treated in our hospital from June 2016 to June 2017 were selected as the study subjects. The patients were divided into two groups according to their electrocardiogram status after treatment, with 100 cases in each group. The total ST elevation of electrocardiogram in group A decreased by more than 50% after treatment, and that in group B decreased by less than 50% after treatment. The occurrence rate of adverse cardiac events, TIMI blood flow classification, FVEF and the influencing factors of serious adverse cardiac events were observed. Results The incidence of diabetes in group A was higher than that in group B, and the infarct related artery （IRA） recanalization time was also significantly less than that in group B, the differences were significant （ P 〈 O. 05 ）. In group A, the number of cases of IRA blood flow less than TIMI2 was less than that of group B after operation, but there was no significant difference （ P 〉 0. 05 ）. The left ventricular ejective fraction（LVEF） of group A was significantly higher than that of group B, and the incidence of cardiac adverse events （7%） was significantly lower than that of group B （25%）, the differences were significant （P 〈 0. 05 ）. Univariate analysis of adverse cardiac events revealed that diabetes, chest pain, and perfusion events and angina before infarction were all possible risk factors for adverse cardiac events. At 2 h after treatment, ST segment elevation, presence of diabetes and onset of IRA to recanalization time were independent risk factors Conclusions In patients with acute myocardial infarction, electrocardiogram have an important predictive effect on the PCI treatment. In the case of myocardial reperfusion, electrocardiogram may be more obvious than the TIMI blood for adverse cardiac events （ P 〈 0. 05 ）. the early changes in the ST segment of the patient＇s short-term prognosis after receiving the decrease of the ST segment of the flow classification.