急性心肌梗死患者行经皮冠状动脉介入治疗后ST 段改变的意义

目的探讨急性心肌梗死患者行经皮冠状动脉介入(PCI)术后早期ST段回落的临床意义。方法选取接受急诊PCI治疗的急性心肌梗死患者32例,根据PCI术后ST段的改变分为ST-T改变组(21例)和无ST-T改变组(11例),同时将ST-T改变组根据发病至PCI治疗时间分为≤6 h组(12例)和>6 h组(9例),分析比较PCI术后1、6、12 h的动态心电图变化特征。PCI术后1、6个月行超声心动图检查,检测左心室射血分数(LVEF)及左心室舒张末期内径(LVDd)。观察≤6 h组与>6 h组ST段回落指数的变化,ST-T改变组与无ST-T改变组的心功能改善情况及远期心血管事件发生情况。结果 PCI治疗后,≤6 h组及>6 h组ST段回落指数均>50%,且术后1、6、12 h的回落指数组间比较差异有统计学意义(P<0.01)。随访期间ST-T改变组LVEF显著高于无ST-T改变组,LVDd低于无ST-T改变组,差异有统计学意义(P<0.05)。ST-T改变组心血管事件发生率明显低于无ST-T改变组(P<0.01,P<0.05)。结论通过观察PCI术后ST-T的动态改变,可了解PCI术后心功能的改善情况,对心血管事件发生的预测有重要的临床意义。

Clinical significance of ST segment changes after percataneous coronary artery intervention in acute myocardial infarction patients

Objective To explore the prognostic significance of early ST segment descent after percataneous coronary artery intervention(PCI) in acute myocardial infarction(AMI) patients.Methods Thirty-two cases with AMI who treated with PCI were divided into ST segment change group(n=21) and non ST segment change group(n=11).And the ST segment change group was divided into two subgroup according to the time from attack to the operation of PCI:≤6 hours group(n=12) and >6 hours group(n=9).The changes of dynamic electrocardiogram were analyzed in l hour,6 hours and 12 hours after PCI.Echocardiography was used to detected the left ventricular ejection fraction(LVEF) and left ventricular end diastolic dimension(LVDd) one month and six months after PCI.The changes of ST-segment descent index in ≤6 hours group and >6 hours group were observed,and the improvement of heart function and long-dated cadiovascular events in ST segment change group and non ST segment change group were observed too.Results After PCI,the descending index of ST segment was more than 50% in ≤6 hours group and >6 hours group;and the descending index of ST segment in l hour,6 hours and 12 hours after PCI had significant difference between the two groups(P<0.01).Compared with non ST segment change group,in ST segment change group,the LVEF was higher,LVDd was lower(P<0.05).The incidence of cadiovascular events in ST segment change group was lower than non ST segment change group(P<0.01,P<0.05).Conclusion The improvement of heart function after PCI can be estimated by the dynamic changes of ST-T,and it is significant clinical significance in pretesting the cadiovascular events.