急性心肌梗死再灌注期间的心电变化特征

The changes of cardiac electricity during reperfusion in acute myocardial infarction

目的 探讨急性心肌梗死 (AMI)再灌注期间的心电变化特征。方法 46例经急诊冠状动脉造影明确为成功再灌注的AMI,其中 2 4例接受溶栓治疗和 2 2例接受直接经皮腔内冠状动脉成形 ,于发病的 6小时内以动态心电图技术持续2 4小时监测心电图变化 ,并与 1 5例无灌注者进行对比。结果 ①再灌注发生后 ,相应导联ST段迅速下降 ,约 2小时达较低水平 ;同时 ,T波正向振幅进行性降低 ,距再灌注 0～ 2 2 (2 7± 4 5)小时呈现T波倒置并逐渐加深。②再灌注后的 1小时内 ,室性心律失常明显增加 ,6～ 8小时后显著减少。结论 AMI早期再灌注发生后呈现特征性心电变化 。

Objective To study the changes of cardiac electricity during reperfusion in acute myocardial infarction(AMI) Methods 46 patients who had successful reperfusion and were diagnosed by acute coronary artery angiography with AMI,including 24 cases treated by successful thrombolytic therapy and 22 cases treated by primary percutaneous transluminal coronary angioplasty,underwent 24 hours Holter monitoring within 6 hours after the symptom onset The changes of ST segment,T wave and ventricular arrhythmia during reperfusion were observed continually and were compared with the results of those who had not reperfusion Results ①ST segment came down rapidly after reperfusion ②T wave upright amplitude became lower significantly after reperfusion and the early T wave inversion were observed from 0 to 22(2 7±4 5) hours of reperfusion ③Ventricular arrhythmia increased remarkably within 1 hours after reperfusion and then decreased markedly after 6～8 hours Conclusion The characteristic changes of cardiac electricity are shown after reperfusion in AMI These characteristics are very important to evaluate clinically successful reperfusion and risk identification