磁刺激治疗神经根型颈椎病的临床疗效  

Correlation study between electrocardiogram features and left ventricular dysfunction in acute anterior ST segment elevation myocardial infarction

作　　者：杨曙艳[1] 肖文涛[2] 王宪沛[2] 晏娟娟[2] 李牧蔚[2] 张优[2] 刘静静[2] 戴国友[2] 高传玉[2] 

机构地区：[1]河南省胸科医院心内科,郑州市450003 [2]郑州大学人民医院心内科

出　　处：《医药论坛杂志》2014年第11期1-4,共4页Journal of Medical Forum

基　　金：河南省科技攻关课题(132102310080)

摘　　要：目的观察磁刺激治疗神经根型颈椎病的临床疗效。方法 2010年1月至2012年12月河南省胸科医院心内科急性前壁ST段抬高心肌梗死(STEMI)患者216例,均行急诊或择期完全血运重建术,资料完整、符合纳入标准的156例均连续入选。依据12h内是否行急诊介入和静脉药物溶栓,分为再灌注组102例和延迟再灌注组54例。收集研究对象的临床资料,并随访梗死后3个月心功能。结果两组患者年龄均数[(60.3±12.5)比(60.2±12.5)]、男性比(83.3%比75.9%),Killip 2~4级[40.0%(43/102)比3.7%(2/54)],以再灌注组较高(P<0.0001)。心电图前壁导联ST段抬高幅度之和(∑ST)、Q波之和(∑Q)以及Q波导联数,与Killip分级、急性期/梗死后3个月的左室舒张末内径(LVEDD)正相关(γ=0.52~0.75,P<0.01),但与急性期/梗死后3个月的左室射血分数(LVEF)负相关(γ=-0.63^-0.95,P<0.01);前壁导联R波振幅之和(∑R),与心肌酶峰值、BNP、急性期/梗死后3个月LVEDD负相关(γ=-0.48^-0.79,P<0.01),但与急性期/梗死后3个月LVEF正相关(γ=0.73~0.82,P<0.01);前壁ST段抬高最大值,与Killip分级、心肌酶峰值、BNP、急性期/梗死后3个月LVEDD正相关(γ=0.41~0.62,P<0.05)。而Q波最大值,与Killip分级、心肌酶峰值、BNP、急性期/梗死后3个月的LVEDD正相关(γ=0.42~0.64,P<0.05)。∑ST、∑Q、∑R和Q波导联数与梗死后3个月NYHA分级不相关(P>0.05)。BNP是左室功能不全的敏感指标,其与STEMI急性期/3个月LVEF呈强负相关(γ=-0.92、-0.80,P<0.01)。梗死后3个月2~4级心功能(NYHA)[24.5%(25/102)比24.0%(13/54)]比较,差异无统计学意义(P均>0.05)。结论急性前壁STEMI心电图ST段、Q波、R波及心肌酶峰与近期左室功能密切相关。Objective To assess the correlation between the ST segment elevation, Q wave with left ventricular dysfunction in acute anterior ST elevation myocardial infarction （STEMI）. Methods A total of 216 consecutive inpatients with acute anterior STEMI from January 2010 to December 2012 in our hospital were enrolled in this study. They were divided into reperfusion （n = 102） and delayed- reperfusion group （n =54）. Clinical data, electrocardiogram parameters were collected by physicians and the patients were followed up for three months. Results Mean years of age （60. 3 ± 12. 5 vs. 60. 2 ±12. 5） and male sex （83.3% vs. 75.9% ） had no significant difference between the two groups （P 〉 0. 05）. Killip grades 2 to 4 [40. 0% （43/102） vs. 3.7% （2/54） ] were significantly higher in reperfusion group than in delayed -reperfusion group （P 〈 0. 0001 ）. The sum of the ST segments elevation, Q waves and Q wave leads in anterior STEMI were positive correlation with the Killip grades. BNP and left ventricle end diastolic diameters （LVEDD） [ γ=0. 52 - 0. 75 ,P 〈 0. 01 ], while negative correlation with left ventricle ejection fraction （LVEF） [ γ = - 0. 63 - -0. 95, P 〈 0. 01 ]. The sum of R wave altitude was negative correlation with myocardium biomarkers, BNP and LVEDD in three months after the onset of STEMI [ γ= - 0.48 - - 0.79, P 〈 0. 01 ], while positive correlation with LVEF [ γ=0.73 -0.82, P〈 0.01]. NYHA grade II to IV three months after infarction [ 24. 5% （ 25/102 ） vs. 24. 0% （13/54） ] were similar between the reperfusion and delayed - reperfusion groups （ P 〉 0. 05 ）. Conclusion There are close correlations between electrocardiogram changes and left ventricular dysfunction in acute anterior ST segment elevation myocardial infarction, which may be strong predictors for the short- term prognosis.

关 键 词：急性心肌梗死 前壁 心电图 心功能 

分 类 号：R245.9[医药卫生—针灸推拿学]