急性心肌梗死自发再通的预测指标及短期预后  

Predictors and short-term prognosis of spontaneous reperfusion in acute myocardial infarction

作　　者：劳咪 李广平[1] 张跃[1] 李虹敏[1] 

机构地区：[1]天津医科大学第二医院心脏科,天津300211

出　　处：《临床荟萃》2014年第1期13-17,共5页Clinical Focus

摘　　要：目的分析急性ST段抬高型心肌梗死(STEMI)梗死相关动脉自发再通患者的临床、介入治疗特点,试图寻找自发再通的预测指标,并评价该部分患者的短期临床预后。方法连续选择天津医科大学第二医院2012年7月1日至2013年5月1日期间住院急性STEMI患者265例,符合入选条件者共153例,根据冠状动脉造影(CAG)中梗死相关动脉血流分级,将其分为再通(SR)组51例,未再通(NSR)组102例。分析两组患者的临床、介入治疗及预后资料特点。结果 SR组造影前T波倒置和胸痛缓解显著高于NSR组(均P<0.05);SR组的肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、肌钙蛋白Ⅰ(cTnI)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)以及白细胞(WBC)水平均显著低于NSR组(均P<0.05),活化部分凝血活酶时间(APTT)水平较高(P<0.05);SR组左心室射血分数明显优于NSR组(P<0.01),住院时间短于NSR组(5.92±1.50)天vs(8.19±2.58)天(P<0.01)。单因素回归分析示造影前T波倒置和造影前胸痛缓解为冠状动脉自发再通的预测指标(均P<0.01);多因素logistic回归分析提示,造影前T波倒置、发病-就诊时间均与冠状动脉自行再通相关。结论紧急CAG前T波倒置和胸痛缓解可作为STEMI患者血管自发再通的预测指标;其梗死相关动脉自发再通可减少心肌梗死面积,改善预后。Objective To study the clinical and angiographic significance of spontaneous reperfusion（SR） in ST elevation myocardial infarction（STEMI）,and to find predictors for the effect on short-term prognosis. Methods A sum of 265 consecutive patients,who were hospitalized in the hospital with acute STEMI between July 2012 and May 2013 were enrolled. Among them, 153 patients were chosen and received emergent coronary angiography（CAG）. Depending on the TIMI grade, the patients were divided into SR group（51 cases）, and NSR group（102 cases）. The clinical, angiographic and prognostic features of the patients were analyzed2 Results T wave inversion and chest pain relief before CAG in SR group were significantly higher than in NSR group （both P 〈0.05） ;The peak levels of CK, CK - MB, cTnI, ALT, AST and WBC in SR group were significantly lower than in NSR group （all P〈0.05）, APTT levels were higher（ P 〈0.05）. The left ventricular ejection fraction in SR group was better than that of NSR group（ P 〈 0. 01） ,and hospitalization time of SR group was shorter,（5.92±1.50） d vs （8.19±2.58） d（ P〈0.01）. Single factor regression analysis showed that T wave inversion and chest pain relief before CAG were predictors for SR （all P〈 0.01）. Multivariable logistic regression analysis showed that T wave inversion before CAG and onset-to-hospital time were associated with SR. Conclusion T wave inversion and chest pain relief before emergency CAG can be used as SR predictors of STEMI patients. SR of the infarction related artery is helpful for reducing myocardial infarction area and improving the prognosis.

关 键 词：心肌梗死 每搏输出量 心电描记术 

分 类 号：R541.4[医药卫生—心血管疾病]