冠状动脉内心电图ST段改变对冠心病患者PCI相关心肌损伤判断价值  

Diagnostic Value of Intracoronary Electrocardiogram ST-segment Change for Percutaneous Coronary Intervention related Myocardial Injury in patients with Coronary Heart Disease

作　　者：李迪[1,2] 刘剑雄[2] 徐俊波[2] 胡咏梅[2] 聂晓莉[2] 李秋[2] 曾朝荣[2] 曾智[1] 

机构地区：[1]四川大学华西医院,四川成都610041 [2]成都市第二人民医院心内科,四川成都610017

出　　处：《四川医学》2016年第4期399-403,共5页Sichuan Medical Journal

摘　　要：目的评价择期经皮冠状动脉介入治疗(Percutaneous Coronary Intervention,PCI)术中冠脉内心电图(Intracoronary Electrocardiogram,IC-ECG)ST段变化对于PCI相关心肌损伤(梗死)(PCI-related Myocardial Injury/Infarction,PMI)的诊断价值。方法连续纳入65例择期PCI的稳定性或不稳定性心绞痛患者,测定术前基础水平及术后6、12、18和24h的血清心肌钙蛋白T(cT nT)水平,记录术中IC-ECG ST段变化。cT nT≥0.1ng/mL为心肌损伤组(PMI组),cT nT<0.1ng/mL为无PMI组,记录PCI术中、术后出现的胸痛,随访术后1至6个月的心脏事件。结果术前cT nT正常者中24例(36.9%)表现为有意义的IC-ECGST段变化(变化组),41例(63.1%)未见有意义的变化(对照组)。PCI手术后30例发生cT nT≥0.1ng/mL(PMI组)中,22例出现有意义的IC-ECG ST改变(ST段改变≥0.1 mv(1mm))的有(91.7%),术后35例cT nT<0.1ng/mL(无PMI组)中,出现有意义的IC-ECG ST改变(ST段改变≥0.1 mv(1mm))仅2例(5.71%),两组差异有统计学意义(=31.714,P<0.001)。Logistic回归显示PCI术中IC-ECG ST改变是心肌损伤的独立预测因素[OR=70.314,95%CI(6.175,800.657),P=0.001]。结论 IC-ECGST段改变能同步监测PMI,具有早期,准确,敏感等特点,为判断PCI术中PMI经济,安全且有效的方法。Objective To evaluate the diagnostic value of intracoronary electrocardiogram（ IC-ECG） ST-segment change for percutaneous coronary intervention（ PCI） related myocardial injury / infarction（ PMI）. Methods 65 consecutive patients with stable or unstable angina scheduled for percutaneous coronary intervention were enrolled. Before intervention and 6,12,18 and 24 hours after intervention,serum cardiac troponin T（ cT nT） levels were tested. And we recorded the IC-ECG ST-segment changes during interventions. The PMI group was defined as cT nT ≥0. 1ng / mL after PCI. And the none-PMI group was defined as cT nT 0. 1ng / mL. The intraoperative and postoperative chest pain,cardiac events during 1 to 6-month postoperative follow-up were recorded. Results All 65 patients＇ serum cT nT levels located in the normal range before interventions. Significant intraoperative ICECG ST-segment changes（ ST-segment change≥0. 1mv） manifested in 24 patients（ change group）,and the other 41 patients did not show significant changes in IC-ECG ST-segment（ control group）. After PCI,PMI was detected in 30 patients,and 22（ 91. 7%）of them showed significant intraoperative ST-segment change. While among the other 35 patients whose serum cT nT 0. 1ng / ml,only 2（ 5. 71%） cases of significant ST-segment change was detected during the PCI. Significant difference was demonstrated by the Chi-square test（ = 31. 714,P〈0. 001）. And Logistic regression analysis showed that intraoperative IC-ECG ST-segment change was an independent predictive factor for myocardial injury[OR = 70. 314,95% CI]6. 175,800. 657）,P = 0. 001]. Conclusion IC-ECG is an effective method for predicting PMI. And IC-ECG ST-segment change can simultaneously and accurately monitor PMI.

关 键 词：冠状动脉介入治疗 心肌损伤 冠状动脉内心电图 

分 类 号：R541.4[医药卫生—心血管疾病]