急性心肌梗死患者PCI术后心电图ST段变化与内皮功能的关系  

Relationship between electrocardiogram ST segment change and endothelial function in patients with acute myocardial infarction after PCI

作　　者：王令红 杨春旺 Wang Linghong;Yang Chunwang(Electrocardiogram Room,Liaocheng Third People's Hospital,Liaocheng 252000,China)

机构地区：[1]聊城市第三人民医院心电图室,252000

出　　处：《国际医药卫生导报》2020年第11期1571-1575,共5页International Medicine and Health Guidance News

摘　　要：目的研究ST段抬高性心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)后心电图ST段和血管内皮功能变化并分析两者间的关系。方法选取2016年8月至2019年8月收治的97例STEMI患者为研究对象,完善相关检查并排除PCI禁忌证后实施急诊PCI进行干预,分别于两组入院时和PCI后1 h进行12导联心电图和血管内皮功能检查,计算ST段回落幅度(STR)并据此将患者分为回落组(STR≥50%,62例)和抬高组(STR<50%,35例),比较两组患者基本资料、PCI前后STR和血管内皮功能各项指标,采用Pearson积差进行相关性分析,采用多因素logistic回归分析研究STEMI患者PCI后STR的影响因素。结果97例STEMI患者PCI后1 h心电图显示STR≥50%者62例(63.92%),回落组发病至梗死相关血管(IRA)再通时间明显少于抬高组(P<0.05),两组患者的年龄、性别、基础疾病、入院心率、梗死部位、术前Killip心功能分级及PCI后TIMI血流分级比较差异均无统计学意义(均P>0.05);PCI后1 h,两组ST段抬高幅度均明显降低(均P<0.05),且回落组低于抬高组(P<0.05),ST段回落幅度回落组高于抬高组(P<0.05);PCI后1 h,抬高组FMD、ABI及血清NO水平均明显降低(均P<0.05),血清ET水平明显升高(P<0.05),回落组FMD、ABI、ba-PWV、ET以及NO均未见明显变化(均P>0.05),且回落组FMD、ABI及NO高于抬高组,ET低于抬高组,差异均有统计学意义(均P<0.05);Pearson极差分析显示FMD、ABI及NO与ST段回落幅度均呈明显正相关性(均P<0.05),ET与ST段回落幅度均呈明显负相关性(均P<0.05);多因素logistic回归分析显示,发病至IRA再通时间和血清ET水平为STR<50%的独立危险因素,血清NO水平则为重要保护性因素(P<0.05)。结论STEMI患者PCI术后仍有较高可能无法获得有效灌注,心电图表现为ST段持续抬高状态,其原因与发病至IRA再通时间和血管内皮功能损害关系密切。Objective To study the changes of electrocardiogram ST segment and vascular endothelial function in patients with ST-segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI),and to analyze the relationship between them.Methods From August 2016 to August 2019,97 patients with STEMI in our hospital were enrolled in the study.The patients were given emergency PCI intervention after completion of relevant examinations and exclusion of PCI contraindications,and 12-lead electrocardiogram and vascular endothelial function examination were performed in the two groups at admission and at 1 h after PCI.The ST-segment resolution(STR)was calculated,and the patients were divided into resolution group(STR≥50%,62 cases)and elevation group(STR<50%,35 cases).Basic data and STR and vascular endothelial function indexes before and after PCI were compared between the two groups,and the correlation analysis was performed by Pearson product moment.Multivariate logistic regression analysis was used to study the influencing factors of STR in STEMI patients after PCI.Results Among 97 patients with STEMI,the electrocardiogram at 1 h after PCI showed that there were 62 cases(63.92%)with STR≥50%,and the time from onset to IRA recanalization in the resolution group was lower than that in the elevation group(P<0.05).There were no statistically significant differences in the age,gender,underlying diseases,heart rate at admission,infarction site,preoperative Killip cardiac function grading,and TIMI blood flow grading after PCI between the two groups(all P>0.05).At 1 h after PCI,the ST-segment elevation degree significantly decreased in the two groups(all P<0.05),and that in the resolution group was lower than that in the elevation group(P<0.05),while the ST-segment resolution degree in the resolution group was higher than that in elevation group(P<0.05).At 1 h after PCI,the FMD,ABI,and serum NO levels significantly decreased in the elevation group(all P<0.05),while serum ET level increased significantly(P<

关 键 词：急性心肌梗死 经皮冠状动脉介入治疗 心电图 内皮功能 

分 类 号：R542.22[医药卫生—心血管疾病]