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目的探讨急性ST段抬高心肌梗死(STEMI)患者缺血再灌注损伤心电图改变及其发生机理。方法分析60例STEMI患者再灌注治疗(溶栓或冠状动脉介入治疗)后缺血再灌注损伤性心电图改变特点及影响因素;根据再灌注治疗后是否发生再灌注损伤性心电图改变而将患者分为再灌注损伤性心电图改变组和再灌注无损伤性心电图改变组;抽静脉血测定活性氧(ROS)、丙二醛(MDA)、还原型谷胱甘肽(GSH)、总抗氧化力(T-AOC)及γ-谷氨酰半胱氨酸合成酶(γ-GCS)活性。结果再灌注心电图心律失常发生率高(65.00%),且以加速性室性自主心律最多见,其次非持续性室速、窦缓和房室传导阻滞;并易出现再灌注损伤性ST段抬高(46.67%)。单因素分析发现冠状动脉血管病变数目、发病至CK达高峰时间、再灌注时间与STEMI患者易发再灌注损伤性心电图改变有关(P<0.05)。溶栓治疗再灌注损伤性心电图改变发生率高于冠状动脉介入治疗(P<0.05)。再灌注心电图改变组血清ROS、MDA显著增高而GSH、T-AOC显著降低;γ-GCS活性高于对照组和缺血组(P<0.05)。结论 STE-MI患者缺血再灌注后再灌注损伤性心律失常与ST段抬高较常见;再灌注复氧后产生氧自由基增多,自由基生成系统/清除系统失衡,可能是发生再灌注损伤性心电图改变重要机制。
Objective To investigate the changes of electrocardiogram and its mechanism of ischemia-reperfusion injury in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods Sixty STEMI patients underwent reperfusion therapy (thrombolysis or coronary intervention) after ischemia reperfusion injury ECG characteristics and influencing factors; according to reperfusion after reperfusion injury ECG changes and patients were divided into The changes of reactive oxygen species (ROS), malondialdehyde (MDA), reduced glutathione (GSH), total antioxidant capacity (T -AOC) and γ-glutamylcysteine synthetase (γ-GCS) activity. Results The incidence of reperfusion arrhythmia was high (65.00%), and was most frequently seen in accelerated ventricular autonomic arrhythmias. Second, non-sustained ventricular tachycardia and sinus atrophy were atrophy and atrioventricular block. High (46.67%). Univariate analysis found that the number of coronary artery lesions, the incidence of CK up to the peak time, reperfusion time and STEMI patients with reperfusion injury prone electrocardiogram changes (P <0.05). The incidence of ischemic electrocardiographic changes after thrombolytic therapy was higher than that of coronary intervention (P <0.05). Serum ROS, MDA and GSH and T-AOC were significantly decreased in the reperfusion electrocardiogram changes group; γ-GCS activity was higher than that in the control group and ischemia group (P <0.05). Conclusions Reperfusion injury arrhythmia and ST segment elevation after reperfusion in STE-MI patients are more common. After reoxygenation, oxygen free radicals increase and imbalance of free radical generation / clearance system may occur, which may result in reperfusion injury ECG changes the important mechanism.