急性前壁心肌梗塞直接经皮冠状动脉腔内成形术成功后ST段持续抬高的临床意义  

Clinical Significance of Persistent ST Segment Elevation Following Successful Direct Percutaneous Transluminal Coronary Angioplasty in Anterior Wall Acute Myocardial Infarction

作　　者：杨明 胡大一[1] 王乐丰[1] 陈方[1] 贾三庆[1] 李田昌[1] 许玉韵[1] 

机构地区：[1]首都医科大学附属北京红十字朝阳医院心脏中心,北京市100020

出　　处：《中国循环杂志》1999年第5期269-271,共3页Chinese Circulation Journal

摘　　要：目的：评价前壁急性心肌梗塞（ＡＭＩ）直接经皮冠状动脉腔内成形术（ＰＴＣＡ）成功后心电图ＳＴ段持续抬高与左心室功能的关系。　　方法：直接ＰＴＣＡ前后１ 小时记录心电图，测量ＳＴ段抬高幅度，根据术后１小时心电图抬高的ＳＴ段下移的幅度将２９ 例ＡＭＩ患者分为２组。Ａ组（ｎ＝ ２０）：患者术后１ 小时抬高的ＳＴ段下移大于５０％ ；Ｂ组（ｎ＝ ９）：患者术后１小时抬高的ＳＴ段下移小于５０％ 。左心室功能测定用超声心动图评价。　　结果：左心室射血分数在急性期２ 组间无明显差异，在３ 个月时左心室射血分数Ａ组较Ｂ组明显增高，分别为０．６４±０．０５及０．４３±０．０８（Ｐ＜ ０．０１），平均随访５±１个月，Ａ组无心功能不全发生，Ｂ组有３例患者出现心功能不全。　　结论：本研究表明，直接ＰＴＣＡ成功后１小时ＳＴ段持续抬高与术后左心室功能恢复不佳有密切关系，在治疗上应采用减轻心脏负荷措施。Objective:To evaluate the relationship between a persistent ST segment elevation following successful direct percutaneous transluminal coronary angioplasty(PTCA)in anterior wall acute myocardial infarction (AMI) and left ventricular function. Methods:ST segment elevation was measured by electrocardiogram recorded before and 1h after PTCA.Twenty nine patients with acute myocardial infarction who had undergone direct PTCA were classified into two groups according to extent of ST segment resolution 1h after PTCA,20 patients with rapid ST resolution 1h after PTCA were defined as a decrease of more than 50% in the ST elevation between the two ECG(group A),9 patients with persistent ST elevation 1h after PTCA were defined as a decrease of less than 50% in the ST elevation between the two ECG(group B),left ventricular function was evaluated by echocardiogram. Results:Left ventricular ejection fraction(LVEF)in the acute stage was identical in both groups.However,LVEF was significantly higher in group A than in group B(0 64±0 05 vs. 0 43±0 08 p <0 01)three months later.At follow up(5±1 months),no myocardial insufficiency occurred in group A,but there were three patients with myocardial insufficiencey in group B. Conclusion:A persistent ST segment elevation after successful direct PTCA was associated with poor recovery of left ventricular function.Attenuating cardiac load was helpful to avoid myocardial insufficiency in these patients.

关 键 词：心肌梗塞 血管成形术 AMI PTCA 心电图 

分 类 号：R542.220.5[医药卫生—心血管疾病] R654.2[医药卫生—内科学]