急性STEMI病人介入术后心肌微循环灌注的影响因素及预测模型构建  

Influencing Factors of Myocardial Microcirculation Perfusion and Prediction Model Construction in Acute STEMI Patients after Intervention Surgery

作　　者：刘霄霄[1] 张万玲[1] 于鹤 宋波 孙红周[1] LIU Xiaoxiao;ZHANG Wanling;YU He;SONG Bo;SUN Hongzhou(Xi'an Northern Hospital,Xi'an 710043,Shaanxi,China)

机构地区：[1]西安市北方医院,西安710043

出　　处：《中西医结合心脑血管病杂志》2025年第8期1197-1202,共6页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

摘　　要：目的:探讨急性ST段抬高型心肌梗死(STEMI)病人介入术后心肌微循环灌注影响因素,并构建基于超声评估的预测模型。方法:回顾性纳入2019年1月—2023年3月于我院接受介入手术治疗急性STEMI病人135例,根据术后心肌微循环灌注状态分为正常组(54例)和异常组(81例),比较正常组和异常组一般资料、冠状动脉造影资料及超声心动图指标;多因素分析急性STEMI病人介入术后心肌微循环灌注异常的影响因素,并分析急性STEMI病人介入术后心肌微循环灌注异常预测模型的效能。结果:异常组心肌肌钙蛋白峰值水平、罪犯血管为前降支比例、单支病变比例、室壁运动积分及二尖瓣舒张早期血流峰速度(E)与舒张早期左心室间隔/侧壁二尖瓣环运动峰速度(Em)均明显高于正常组(P<0.05);异常组罪犯血管为右冠状动脉比例、三支病变比例、二尖瓣E峰减速时间均明显低于正常组(P<0.05)。多因素分析结果显示,心肌肌钙蛋白峰值水平、罪犯血管、二尖瓣E/Em、室壁运动积分、二尖瓣E峰减速时间均是心肌灌注异常的独立影响因素(P<0.05)。结论:急性STEMI病人介入术后心肌微循环灌注异常发生受心肌肌钙蛋白峰值水平、罪犯血管类型、二尖瓣E/Em、室壁运动积分及二尖瓣E峰减速时间独立影响;而基于上述因素构建的模型在预测介入术后心肌微循环灌注异常发生方面具有良好效能。Objective:To explore the influencing factors of myocardial microcirculation perfusion in patients with acute ST-segment elevation myocardial infarction(STEMI)after interventional therapy and to construct a predictive model based on ultrasound assessment.Method:A total of 135 patients with acute STEMI who underwent interventional surgery were included.According to the postoperative myocardial microcirculation perfusion status,the patients were divided into normal group(54 cases)and abnormal group(81 cases).The general data,coronary angiography data and echocardiographic indicators of the two groups were compared.Multivariate analysis was conducted to explore the influencing factors of abnormal myocardial microcirculation perfusion in patients with acute STEMI after interventional surgery,and the efficacy of the predictive model for abnormal myocardial microcirculation perfusion in patients with acute STEMI after interventional surgery was analyzed.Results:The results showed that the peak level of myocardial troponin,the proportion of culprit vessels being the left anterior descending artery,the proportion of single-vessel disease,the wall motion score index and the ratio of early diastolic transmitral velocity to early diastolic mitral annular velocity(E/Em)were significantly higher in the abnormal group than those in the normal group(P<0.05).The results of multivariate analysis showed that the peak level of cardiac troponin,culprit vessel,mitral valve E/Em,wall motion score,and deceleration time of mitral valve E wave were independent influencing factors of myocardial perfusion abnormality(P<0.05).Conclusion:The occurrence of myocardial microcirculatory perfusion abnormalities in acute STEMI patients after interventional surgery is independently influenced by the peak level of cardiac troponin,culprit vessel type,mitral valve E/Em,wall motion integral,and mitral valve E peak deceleration time.The model built based on the above factors shows better efficacy in predicting the occurrence of abnormal myocardial micro

关 键 词：ST段抬高型心肌梗死 介入手术 心肌微循环 预测价值 

分 类 号：R541.4[医药卫生—心血管疾病]