急性ST段抬高性前壁心肌梗死直接冠脉介入治疗ST段变化与左心室功能的关系  

Relationships between ST Segment Changes and Left Ventricular Function in Patients with Acute ST Segment Elevation Anterior Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention

作　　者：阿木提.司马义[1] 郭军[1] 陈晓洋[1] 王勇[1] 马丽[1] 米日古丽[1] 李杰[1] 王钊[1] 穆叶塞[1] 李国庆[1] 雷建新[1] 戴晓燕[1] 任澎[1] 

机构地区：[1]新疆维吾尔自治区人民医院心内科,乌鲁木齐830001

出　　处：《医学研究杂志》2010年第11期30-33,共4页Journal of Medical Research

基　　金：美国中华医学会基金(CMB;96-657)

摘　　要：目的探讨急性ST段抬高性前壁心肌梗死患者(ST segment elevation myocardial infarction)直接PCI(primary percuteous coronary intervention,PCI)ST段变化与左心室功能的关系。方法入选91例前壁STEMI直接PCI患者,其梗死相关动脉为左前降支,急诊PCI术后前向血流达TIMI3级。将入选患者分为两组:心功能不全患者为病例组(n=41);心功能正常患者为对照组(n=50)。结果心功能不全患者的ST段抬高幅度术前、术后无明显变化(P=0.067),而心功能正常患者直接PCI术后ST段显著降低(P=0.001)。术后1h,心功能正常较心功能不全患者的ST段回落明显(P=0.001)。心功能正常患者ST段回落<50%占18%(9/50),ST段进一步抬高的占8%(4/50);心功能不全患者ST段回落<50%占68.3%(28/41),ST段进一步抬高的占31.7%(13/41)(P=0.001)。术后2周,心功能正常患者的ST段基本回落至等电位线,其中ST段回落<50%的患者占12%(6/50),室壁运动改善;而心功能不全患者ST段抬高数值为0.22±0.07mv,ST段回落<50%的患者占36.6%(15/41),室壁运动减弱,积分增加,左心室舒张末期容积增加,左心室扩张(P=0.001)。直线回归方程提示:心功能不全患者的室壁运动积分和ST段抬高指数呈正相关(r=0.65,P=0.001);心功能正常患者两者亦呈正相关(r=0.7,P=0.001)。结论前壁STEMI直接PCI术后ST段的变化,可反映心肌再灌注后的心功能情况,对早期临床预后评估和区分高危患者有积极意义。Objective To investigate the relationships between ST segment changes and left ventricular function in patients with acute ST segment elevation anterior myocardial infarction treated by primary percutaneous coronary intervention. Methods Ninety - one patients with acute ST segment elevation anterior myocardial infarction were enrolled. Infarction relate artery was left artery of decentand and angiographic anterior flow thrombolysis in myocardial infarction（TIMI） was 3 Grade. All the patients were divided into two groups： case group with forty - one patients of left ventricular dysfunction and control group with fifty patients of normal left ventricular function. Re- sults Magnitudes of ST segments elevation was not significant in patients of disease group before and after PCI （P = 0. 067）, but was significant in patients of control group before and after PCI（P = 0. 001 ）. One hour afert PCI, the ST elevation segments resolved rapidly in control group, in comparison with patients of case group（P =0. 001 ）. ST segment resolution 〈50% was 18% （9/50） , and ST segment elevation furthermore was 8% （4/50） in control group; but ST segment resolution 〈 50% was 68.3% （28/41） , and ST segment elevation furthermore was 31.7% （13/41） in case group（P =0. 001 ）. Two weeks afert PCI, ST segment resolved to normal almost, and ST seg- ment resolution 〈 50% was 12% （6/50） , ventricular wall motion improved in normal eontroll group; but ST segments elevation was 0.22 ＋- 0. 07my, and ST segment resolution 〈 50% was 36.6% （ 15/41 ） , and ventricular wall motion decreased, and left ventricular end - diastolic diameter and left ventricular end - diastolic volume increased in patients of case group （ P = 0. 001 ）. Linear regression analysis showed a significant relation between WMS and ST segment elevation index in patients with left ventricular dysfunction who underwent PCI after two weeks（r = 0.65, P = 0. 001 ） , and also showed a significant relation in normal left ventr

关 键 词：急性ST段抬高性前壁心肌梗死 介入干预 ST段 左心室功能 

分 类 号：R542.22[医药卫生—心血管疾病]