ST段抬高型心肌梗死患者冠状动脉自发性再灌注与对应导联T波倒置的关系  

Relationship between spontaneous reperfusion of infarct-related arteries and T-wave inversion of corre-sponding leads in patients with ST-segment elevation myocardial infarction

作　　者：郜黎伟[1] 赵剑峰[1] 潘双花 郝英才 朱红涛[1] GAO Liwei;ZHAO Jianfeng;PAN Shuanghua;HAO Yingcai;ZHU Hongtao(Department of Cardiology,People's Hospital of Danyang,Zhenjiang Jiangsu 212300,China;Department of Electrocardio-gram,People's Hospital of Danyang,Zhenjiang Jiangsu 212300,China)

机构地区：[1]丹阳市人民医院心内科,江苏镇江212300 [2]丹阳市人民医院心电图室,江苏镇江212300

出　　处：《实用心电学杂志》2022年第4期267-271,共5页Journal of Practical Electrocardiology

基　　金：江苏省卫生健康委员会面上项目(M2020077)。

摘　　要：目的探讨早期心电图T波倒置与急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者梗死相关动脉发生自发性再灌注(spontaneous reperfusion,SR)的关系。方法回顾性分析246例急性STEMI住院患者,以发病6 h内的心电图(院前急救系统或急诊室所做的第一份心电图)作为判断早期T波形态的标准;所有患者接受急诊经皮冠状动脉介入治疗。详细记录患者的临床资料、心电图及血管造影数据,并依据梗死相关血管对应导联T波是否倒置,分为T波倒置组(33例)和T波直立组(213例)。根据冠状动脉造影结果,比较两组SR的发生率。结果246例患者中,92例(37.4%)梗死相关血管出现SR;有120例(48.8%)前降支闭塞,28例(11.4%)回旋支闭塞,98例(39.8%)右冠状动脉闭塞。在前降支闭塞的患者中,23例(19.2%)T波倒置;而在回旋支及右冠状动脉闭塞的患者中,分别有2例(7.1%)、8例(8.2%)发生T波倒置。在前降支闭塞伴T波倒置的STEMI患者中,冠状动脉造影显示19例(82.6%,P<0.01)发生SR;而回旋支闭塞伴T波倒置患者中只有1例(50.0%,P=0.124),右冠状动脉闭塞伴T波倒置患者中有3例(37.5%,P=0.035)发生SR。结论前降支闭塞的STEMI患者心电图中,伴ST段抬高的导联出现早期T波倒置可能提示梗死相关动脉出现SR。Objective To explore the relationship between spontaneous reperfusion(SR) of infarct-related arteries and T-wave inversion in early ECGs of patients with acute ST-segment elevation myocardial infarction(STEMI). Methods A total of 246 acute STEMI inpatients were retrospectively analyzed. The ECG within the first 6 hours of onset(the first ECG recorded by the pre-hospital emergency system or the emergency room) was taken as a criterion of determining the morphology of T-wave in an early phase. All the patients received emergency percutaneous coronary intervention. The patients’ clinical data, ECGs and angiography data were recorded in detail. According to the presence or absence of inverted T-wave in the corresponding leads of infarct-related vessels, the enrolled subjects were divided into T-wave inversion group(33 cases) and T-wave upright group(213 cases). The incidence of SR was compared between the two groups according to the results of coronary angiography. Results In the 246 patients, SR is found in infarct-related vessels of 92 patients(37.4%);occlusion occurs in the anterior descending arteries of 120 patients(48.8%), the circumflex arteries of 28 patients(11.4%), and the right coronary arteries of 98 patients(39.8%). Among the patients with occluded anterior descending arteries, T-wave inversion is found in 23 patients(19.2%) while only 2 patients(7.1%) with circumflex artery occlusion and 8 patients(8.2%) with right coronary artery occlusion are recorded T-wave inversion in ECGs. In the STEMI patients with anterior descending artery occlusion and inverted T-wave, SR is confirmed in 19 patients(82.6%, P<0.01) by coronary angiography;only one case(50.0%, P=0.124) of SR is found in patients with circumflex artery occlusion and inverted T-wave;3 cases(37.5%,P=0.035) of SR are found in patients with right coronary artery occlusion and inverted T-wave. Conclusion In the ECGs of STEMI patients with anterior descending artery occlusion, early T-wave inversion in the leads with ST-segment elevation may be a pre

关 键 词：ST段抬高型心肌梗死 T波倒置 自发性再灌注 梗死相关动脉 

分 类 号：R541.75[医药卫生—心血管疾病] R540.4[医药卫生—内科学]