急性前壁ST段抬高心肌梗死患者再灌注时间对心电图和心肌酶学的影响  

Effect of reperfusion time on ECG features and cardiac enzymes in patients with acute anterior ST segment elevation myocardial infarction

作　　者：杨曙艳[1] 张优[2] 刘静静[3] 戴国友[3] 肖文涛[3] 王宪沛[3] 晏娟娟[3] 李牧蔚[3] 胡大一[2] 高传玉[3] 

机构地区：[1]河南省胸科医院,郑州450008 [2]郑州大学人民医院流行病学中心 [3]郑州大学人民医院心内科

出　　处：《中华心脏与心律电子杂志》2014年第4期25-30,共6页Chinese Journal of Heart and Heart Rhythm(Electronic Edition)

基　　金：河南省科技攻关课题(132102310080)

摘　　要：目的探讨再灌注方式对急性前壁ST段抬高心肌梗死（STEMI）的心电图特征与心肌酶学变化之间的关系。方法2010年1月至2012年12月急性前壁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12 h内是否行急诊介入和静脉药物溶栓，分为早期再灌注组（n＝102）和延迟再灌注组（n＝54）。收集研究对象的临床资料，心电图和心肌酶学变化。定量资料正态性检验选择Kolmogorov-Smirnova检验，组间分布的比较选择Mann-Whitney U检验，均数比较选择t检验。率或构成比的比较，选择χ2检验。结果早期再灌注组和延迟再灌注组，年龄[（60．3±12．5）岁比（60．2±12．5）岁]、男女比例[83．3％（83／102）比75．9％（41／54）]，差异无统计学意义（P＞0．05）；但早期再灌注组急性期Killip 2-4级发生率较高[40．0％（43／102）比3．7％（2／54）]、早期再灌注组心肌酶学峰值均高于延迟再灌注组（P＜0．01）。酶学达峰时间比延迟再灌注组达峰时间明显缩短[（11．3±2．1）h 比（17．4±4．6）h，P＜0．01]。左心室射血分数、左心室直径与肌酸磷酸激酶同功酶，肌钙蛋白密切相关（r分别为－0．74、－0．79和0．54、0．60， P＜0．01）。心电图前壁导联ST段抬高幅度之和、Q波之和以及Q波导联数，前壁ST段抬高最大值，与Killip分级、心肌酶峰值、脑钠肽呈正相关（r＝0．41-0．62，P＜0．05）。结论急性前壁STEMI患者心电图Q波、ST段、R波、心肌酶峰值与左心室射血分数、左心室直径密切相关。除左心室射血分数外，早期再灌注组优于延迟再灌注组。Objective To investigate the effect of reperfusion time on ECG features and cardiac enzymes in patients with acute anterior ST segment elevation myocardial infarction （STEMI）.Methods A total of 21 6 consecutive inpatients with acute anterior STEMI from January 201 0 to December 201 2 in our hospital were enrolled in this study.1 56 of 21 6 cases were with complete data.They were divided into early reperfusion （n =1 02 ） and delayed reperfusion group （n =54 ） depending on whether reperfusion in 1 2 hours.Clinical data,electrocardiogram parameters were collected by physicians.Results Mean years of age （60.3 ±12.5）vs （60.2 ±12.5）and male sex [83.3%（83/102）vs 75.9%（41/54）]had no significant difference between the two groups （P〉0.05）.Killip grades 2 to 4 [40.0%（43/1 02）vs 3.7%（2/54）]and peak cardiac-enzymes were significantly higher in early reperfusion group than in delayed reperfusion group （P〈0.01 ）.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 ） [r=0.52-0.75,P〈0.01 ] and negative correlation with left ventricle ejection fraction （LVEF）（r =-0.63 --0.95,P〈0.01 ）,while no significant correlation with plasma peak cardiac＆amp;nbsp;enzyme level （P〈0.01 ）.All parameters in early reperfusion group except LVEF were much better than in delayed reperfusion group.Conclusion There are closer correlations for early reperfusion group than in delayed reperfusion group between electrocardiogram,myocardial biomarkers and left ventricular dysfunction in acute anterior ST segment elevation myocardial infarction,and non significant correlation with plasma peak cardiac enzyme level.

关 键 词：心肌梗死 心电描记术 心肌酶学 心功能 再灌注 

分 类 号：R542.22[医药卫生—心血管疾病]