直接经皮冠状动脉腔内成形术中冠状动脉内心电图判定存活心肌的价值  

The clinical value of the intracoronary electrocardiogram for detecting myocardial viability during coronary angioplasty in acute myocardial infarction

作　　者：吴伟力[1] 傅向华[1] 马宁[1] 谷新顺[1] 李世强[1] 李亮[1] 刘君[1] 姜云发[1] 郝国桢[1] 

机构地区：[1]河北医科大学第二医院心内科干部病房,石家庄050000

出　　处：《中华心血管病杂志》2003年第3期184-188,共5页Chinese Journal of Cardiology

摘　　要：目的　应用99mTc MIBI心肌断层显像 (SPECT)评价冠状动脉内心电图 (IC ECG)判定急性心肌梗死 (AMI)存活心肌的价值。方法　 5 6例急性前壁心肌梗死患者 ,接受了直接经皮冠状动脉腔内成形术 (PTCA) ,梗死相关动脉前降支 (LAD)达到TIMI3级血流后IC ECG自PTCA导引导丝尾端引出作为参照基线 ,在进一步球囊扩张时IC ECGST段再次抬高大于 0 2mV时认为具有判定梗死相关部位有存活心肌的意义。测定并比较急性期及恢复期左心室梗死相关区域节段性缩短率 (LVSS)与射血分数 (LVEF) ,梗死区域存活心肌通过恢复早期静息与硝酸甘油介入两次99mTc MIBISPECT量化判定。结果　 41例病人 (A组 )行直接PTCA时IC ECGST段明显抬高 ,15例 (B组 )未出现相应变化 ,A组LVSS、LVEF在恢复期均显著大于B组 ,两次99mTc MIBISPECT显示 ,硝酸甘油介入后显像A组梗死缺损区面积明显减少 ,核素放射性计数百分比亦明显增加 ,B组则无明显改变 ,说明A组梗死区域有较多存活心肌 ,与IC ECTST段抬高意义一致。结论　直接PTCA过程中可通过球囊扩张时IC ECGST段抬高变化初步判定梗死相关区域的心肌活性。Objective To explore the clinical value of the intracoronary electrocardiogram (IC-ECG) for detecting myocardial vability in acute myocardial infarction and to evaluate it by? 99m Tc-MIBI SPECT and left ventriculogram. Methods IC-ECG, recorded from the tip of a guidewire during direct PTCA, were obtained in 56 patients with reperfused anterior myocardial infarction. Further ST segment elevation of more than 0.2 mV detected during the balloon inflation was taken as significance. The infarct area was defined as viable when the redionuclide scintigraphic defect size significantly reduced and the percentage of redionuclide scintigraphic count significantly increased comparing the rest images with those of nitroglycerin interventional? 99m Tc-MIBI tomography. The left ventricular segmental shortening was measured from left ventriculograms recorded at acute and chronic stages. Results During PTCA, significant ST segment elevation was found in 41 patients (Group A); the ST segment was not significantly elevated in the other 15 patients (Group B). The infarct area left ventricular segmental shortening of Group A was greater than those of Group B either in acute or chronic stage of AMI. The defect size significantly reduced and percentage of redionuclide scintigraphic count significantly increased in Group A between rest and nitroglycerin interventional? 99m Tc-MIBI tomography, but Group B had no such changes. These foundings indicated that more viable myocardium existed in the infarct area of Group A, which was consistent with the significance of IC ECG ST segment elevation during PTCA. Conclusion The myocardium within infarct area can be regarded as viable when a further ST segment elevation occurs on intracoronary ECG during direct PTCA. It is, therefore, useful to monitor ECG during coronary angioplasty balloon inflation to assess the myocardial viability of the infarct area.

关 键 词：心电图 经皮冠状动脉腔内成形术 心肌梗塞 心肌活性 PICA 心肌缺血 

分 类 号：R541.4[医药卫生—心血管疾病]