急诊冠状动脉介入治疗对ST段抬高心肌梗死患者跨室壁复极离散度的影响  

Influence of primary PCI on transmural dispersion of repolarization in patients with ST-elevated myocardial infarction

作　　者：姚青海[1] 吴尚勤[1] 孙姗[1] 杨琦[1] 程爱娟[1] 

机构地区：[1]天津市胸科医院心内七科,300051

出　　处：《中华老年心脑血管病杂志》2011年第2期125-128,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的探讨急诊PCI对急性ST段抬高心肌梗死(STEMI)患者跨室壁复极离散度的影响。方法选择STEMI患者341例,其中未能实现梗死相关冠状动脉再通者129例为非再通组,经急诊PCI再通者212例为再通组;另选择非冠心病者36例为对照组。以校正的T波顶点至终点时间(Tp e/c,Tp-e/RR^(1/2))作为跨室壁复极离散度量化指标。比较正常者与STEMI患者、再通组与非再通组的Tp-e/c值:以及影响急诊PCI术后Tp-e/c下降幅度的相关因素。结果非再通组Tp-e/c较对照组明显升高(P<0.01),且在入院即刻、第2、3天差异无统计学意义(P>0.05)。再通组不同梗死相关冠状动脉在术后即刻、第2、3天Tp-e/c下降幅度差异无统计学意义(P>0.05)。再通组Tp-e/c下降幅度与ST段回落程度、肌酸激酶同工酶、肌钙蛋白I、左心室舒张末内径呈独立正相关(r=0.381,r=0.238,r=0.201,r=0.147,P<0.01),与LVEF、Killip分级呈独立负相关(r=-0.1 98,P<0.01;r=-0.1 62,P<0.05)。结论急诊PCI能有效降低患者跨室壁复极离散度,该效果与不同梗死相关冠状动脉无关,而与ST回落程度、心肌标记物水平及左心室收缩功能有关。Objective To probe the effects of primary PCI on transmural dispersion of repolarization（TDR） in patients with ST-elevated myocardial infarction. Methods 341 cases with STEMI were enrolled and divided into revascularized group （n = 212） and unrevaseularized group （n = 129）according to whether successful primary PCI was accomplished. Other cases who had no coro- nary heart disease constituted the control group （n = 36）. TDR was quantified as Tpeak-Tend/ RR1/2, which was nominated as Tp-e/c. The Tp-e/e values in control group, revaseularized group and unrevascularized group were compared,and the influential factors of reduction of Tp-e/c（pre- and post-primary PCI） were detected. Results Although Tp-e/e in unrevascularized group was much higher than that in control group, there was no significant difference of Tp-e/c at time of admission,and on 2nd day or 3rd day （P 〉 0.05）. There was no marked difference of Tp-e/c re- duction at the above-mentioned time-points despite different infarction-related arteries（IRA, P〈0.05）. Reduction of Tp-e/e had independent positive correlation to total ST-descent, CK-MB and cTnI;and had independent negative correlation to LVEF or Killip classification. Conclusion Acute STEMI is characterized by significantly increased TDR which sustains a high level on the first 3 days at least. Primary PCI is benifieial to reduction of TDR. Reduction of Tp-e/e is related to ST-descent,serum level of myocardial markers and left ventricular systolic function,while has nothing to do with different IRA.

关 键 词：心肌梗死 肌酸激酶 血管成形术 经腔 经皮冠状动脉 心律失常 心性 肌钙蛋白I 

分 类 号：R542.22[医药卫生—心血管疾病]