缺血分级在急性ST段抬高型心肌梗死的临床价值  

Clinical value of ischemia grading in patients with ST-segment elevation acute myocardial infarction

作　　者：林晓明[1] 杨希立[1] 刘鹤龄[1] 刘伟斌[1] 

机构地区：[1]佛山市第一人民医院心内科,广东佛山528000

出　　处：《岭南心血管病杂志》2016年第1期30-33,共4页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨缺血分级对接受急诊经皮冠状动脉介入(primary percutaneous coronary intervenfion,PPCI)治疗的急性ST段抬高型心肌梗死(ST-segment elevation acute myocardial infarction,STEMI)患者的临床价值。方法对接受PPCI治疗的STEMI患者181例,按心电图表现分为Ⅱ级缺血组和Ⅲ级缺血组,观察两组院内心血管事件的发生率,分析患者术后心电图ST段回落与心电图缺血分级的关系。结果Ⅲ级缺血组血清肌酸激酶同工酶(CK-MB)浓度明显高于Ⅱ级缺血组,差异有统计学意义[(370±115)U/I vs.(211±91)U/I,P<0.01];左心室射血分数明显低于Ⅱ级缺血组,差异有统计学意义(38%±12%vs.53%±11%,P<0.05)。Ⅲ级缺血组恶性室性心律失常,心源性猝死,心力衰竭,严重房室传导阻滞等心血管事件发生率(34.0%,12.6%,42.7%,35.0%)明显高于Ⅱ级缺血组(14.1%,3.8%,17.9%,15.4%),差异有统计学意义(P<0.01)。PPCI治疗后2 hⅢ级缺血组ST段回落一半及以上和ST段完全回落发生率(32.0%,22.3%)明显低于Ⅱ级缺血组(44.9%,38.5%),差异有统计学意义(P<0.05;P<0.01);PPCI治疗后24 hⅢ级缺血组ST段完全回落的发生率也明显低于Ⅱ级缺血组,差异有统计学意义(54.4%vs.84.6%,P<0.001)。COX风险比例模型单因素分析结果显示,Ⅲ级缺血是心肌梗死患者心源性猝死和心血管事件的独立预警指标(P<0.01)。结论Ⅲ级缺血是STEMI患者住院期间心血管事件和ST段回落不良的独立预测因子。Objectives To investigate the clinical value of ischemia grading in patients with ST-segment elevation acute myocardial infarction （STEMI） undergoing primary percutaneous coronary intervention （PPCI）. Methods Totally 181 STEMI patients undergoing PPCI were classified as grade 2 ischemia （GI2） group and grade 3 ischemia （GI3） group. Incidence of cardiovascular events and relationship between electrocardiographic ST-segment resolution and grade of isehemia in patiens with STEMI after PPCI were observed. Results Creatine Kinase-MB of GI3 group was significantly higher than that of GI2 group [ （370± 115） U/I vs. （211±91 ） U/I, P〈0.01 ]. Left ventricular ejection fraction （LVEF） of GI3 group was obviously lower than that of GI2 group （38%±12% vs. 53%±11%,P〈0.05）. Incidence rates of cardiovascular events including ventricular arrhythmia, sudden cardiac death, heart failure and severe atrioventricular block of GI3 group （34.0%, 12.6%, 42.7%, 35.0%） were higher than those of GI2 group （14.1%, 3.8%, 17.9%, 15.4%）, the differences were significant （P〈0.01）. Incidence rates of ST-segment resolution of GI3 group were significantly lower than those of GI2 group in 2 h（32.0% vs. 44.9% ,P〈0.05,22.3% vs. 38.5% ,P〈0.01） and 24 h （54.3% vs. 83.4%, P〈0.01 ） after PPCI. Multivariate Cox regression analysis showed that GI3 is an independent predictor of sudden cardiac death and cardiovascular events in patients with STEMI. Conclusions GI3 is an independent predictor of cardiovascular events and ST-segment resolution in patients with STEMI.

关 键 词：心肌梗死 缺血分级 血管成形术 经腔 经皮冠状动脉 预后 

分 类 号：R542.22[医药卫生—心血管疾病]