急性ST段抬高型心肌梗死自溶现象的影响因素分析

目的 分析急性ST段抬高型心肌梗死(STEMI)的自溶(SR)现象,探讨SR的影响因素.方法 148例STEMI患者按照有无自溶现象分为自溶组(27例)和非自溶组(121例),分析其临床资料特点、冠状动脉造影结果及预后.结果 SR组与非SR组比较,年龄、性别、高血压、吸烟史等一般临床资料差异无统计学意义.SR组糖尿病患病率低于非SR组(P<0.01).SR组梗死前心绞痛发生率显著高于非SR组(P<0.01).两组左室功能、冠状动脉造影结果的差异无统计学意义.两组再发心肌梗死和病死率差异无统计学意义.SR组室颤发生率高于非SR组(P<0.05).结论 梗死前心绞痛有利于STEMI患者的梗死相关动脉(IRA)发生自溶,而患有糖尿病不利于IRA的自溶.针对室颤的抢救措施可能有助于IRA发生自溶.

Objective To analyse spontaneous coronary recanalization(SR)in acute ST elevation myocardial infarction(STEMI),and to identify the influence factor relating to SR. Methods 148 STEMI patients was divided into SR group(27 cases)and non-SR group(121 cases) according to the phenomenon of spontaneous recanalization,the clinical data,angiographic features and prognosis were analyzed. Results There was no significant difference about general clinical data(age,sex,hypertension,smoking etc.)between the two groups;compared with non-SR group, the occurrence of diabetes was lower in the SR group(P<0.01). SR group had a significantly higher incidence of preinfarction angina(P<0.01);there were no significant differences in left ventricular function,coronary angiography,reinfarction and mortality;compared with non-SR group,the occurrence of ventricular fibrillation was higher in the SR group(P<0.05). Conclusion Preinfarction angina contributes to SR in STEMI patients, diabetes makes no contribution to SR. Emergency measures to ventricular fibrillation may contribute to SR.