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目的探讨急性ST段抬高性前壁心肌梗死患者(ST segment elevation myocardial infarction)直接PCI(primary percuteous coronary intervention,PCI)ST段变化与左心室功能的关系。方法入选91例前壁STEMI直接PCI患者,其梗死相关动脉为左前降支,急诊PCI术后前向血流达TIMI3级。将入选患者分为两组:心功能不全患者为病例组(n=41);心功能正常患者为对照组(n=50)。结果心功能不全患者的ST段抬高幅度术前、术后无明显变化(P=0.067),而心功能正常患者直接PCI术后ST段显著降低(P=0.001)。术后1h,心功能正常较心功能不全患者的ST段回落明显(P=0.001)。心功能正常患者ST段回落<50%占18%(9/50),ST段进一步抬高的占8%(4/50);心功能不全患者ST段回落<50%占68.3%(28/41),ST段进一步抬高的占31.7%(13/41)(P=0.001)。术后2周,心功能正常患者的ST段基本回落至等电位线,其中ST段回落<50%的患者占12%(6/50),室壁运动改善;而心功能不全患者ST段抬高数值为0.22±0.07mv,ST段回落<50%的患者占36.6%(15/41),室壁运动减弱,积分增加,左心室舒张末期容积增加,左心室扩张(P=0.001)。直线回归方程提示:心功能不全患者的室壁运动积分和ST段抬高指数呈正相关(r=0.65,P=0.001);心功能正常患者两者亦呈正相关(r=0.7,P=0.001)。结论前壁STEMI直接PCI术后ST段的变化,可反映心肌再灌注后的心功能情况,对早期临床预后评估和区分高危患者有积极意义。
Objective To investigate the relationship between left ventricular function and ST segment elevation in patients with acute ST elevation myocardial infarction (ST segment elevation myocardial infarction) and primary percute coronary intervention (PCI). Methods Ninety-one patients with anterior wall STEMI direct PCI were enrolled in this study. The infarct-related arteries were left anterior descending coronary artery. The antegrade flow of TIMI3 grade was achieved after emergency PCI. The patients were divided into two groups: patients with cardiac insufficiency as the case group (n = 41); patients with normal cardiac function as the control group (n = 50). Results In patients with cardiac insufficiency, there was no significant difference in ST segment elevation before and after surgery (P = 0.067), while the ST segment in patients with normal cardiac function was significantly decreased after PCI (P = 0.001). At 1h after surgery, the ST segment of normal cardiac function was significantly lower than that of patients with cardiac insufficiency (P = 0.001). In patients with normal cardiac function, ST-segment regression <50% accounted for 18% (9/50), ST-segment elevation further accounted for 8% (4/50) 41), and further elevation of the ST segment accounted for 31.7% (13/41) (P = 0.001). At 2 weeks after operation, the ST segment of patients with normal cardiac function basically dropped to the equipotential curve, of which, 12% (6/50) of patients with ST-segment fallback <50% and wall motion improved; while ST-segment elevation The high value was 0.22 ± 0.07mv. The percentage of patients with ST segment regression <50% was 36.6% (15/41). The wall motion was weakened, the score increased, the volume of left ventricular end-diastolic volume increased, and the left ventricle dilated (P = 0.001). The linear regression equation indicated that there was a positive correlation between wall motion score and ST segment elevation index in patients with cardiac insufficiency (r = 0.65, P = 0.001), and those with normal cardiac function (r = 0.7, P = 0.001) . Conclusion The changes of ST segment after anterior PCI with STEMI can reflect the cardiac function after myocardial reperfusion, and have positive significance for early clinical prognosis evaluation and differentiation of high-risk patients.