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目的:观察急性ST段抬高型心肌梗死(STEMI)直接经皮冠状动脉介入治疗(PCI)时心电的变化,以探讨其临床意义。方法:分析STEMI患者急诊PCI时心电图变化,包括出现不同类型的心律失常及不同ST段回落程度与冠状动脉血流关系。结果:在200例STEMI患者中,梗死相关血管(IRA)开通前存在室性心律失常86例。IRA开通后出现室性心律失常112例。PCI后ST段明显回落组为126例,ST段部分回落组45例,ST段无变化组29例。结论:IRA开通后常可出现心律失常,有时甚至是致命性心律失常,通过严密监测、及早发现和处理均可转危为安;当ST段回落明显时,开通IRA冠状动脉血流较好;而ST段回落较差与再灌注血流不良相关联。因此心电监测是保证直接PCI顺利进行的关键,有着十分重要的临床意义。
Objective: To observe the changes of electrocardiogram (ECG) in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing direct percutaneous coronary intervention (PCI) to investigate its clinical significance. Methods: The changes of electrocardiogram (ECG) in patients with STEMI during PCI were analyzed, including the different types of arrhythmia and the relationship between different ST segment regression and coronary blood flow. Results: In 200 STEMI patients, there were 86 ventricular arrhythmias before infarction-related vessel (IRA). 112 cases of ventricular arrhythmia after IRA opened. There were 126 cases in ST-segment depression group, 45 cases in ST-segment depression group and 29 cases in ST-segment non-change group. Conclusion: Arrhythmia and sometimes fatal arrhythmia can often occur after the opening of IRA. The monitoring and early detection and treatment of IRA can turn critically ill. When the ST-segment depression is obvious, the opening of IRA coronary artery blood flow is better; while ST-segment Poor fallback correlates with poor blood flow to reperfusion. Therefore, ECG monitoring is to ensure the success of direct PCI key, has a very important clinical significance.