临床误诊误治
臨床誤診誤治
림상오진오치
CLINICAL MISDIAGNOSIS & MISTHERAPY
2014年
7期
109-113
,共5页
心肌梗死%血管成形术,气囊,冠状动脉%心律失常%预测
心肌梗死%血管成形術,氣囊,冠狀動脈%心律失常%預測
심기경사%혈관성형술,기낭,관상동맥%심률실상%예측
Myocardial infarction%Angioplasty,balloon,coronary artery%Arrhythmias%Forecasting
目的：探讨经皮冠状动脉（冠脉)介入术（PCI)后 ST 段回落幅度（STR)、Tp-ec 间期和 Tp-e/ QT 比值变化与急性 ST 段抬高型心肌梗死（ST segment elevation myocardial infarction, STEMI)后恶性心律失常事件（malignant arrhyth-mia events, MAE)的关系。方法选择我院经冠脉造影确诊并在12 h 内行 PCI 治疗的92例 STEMI 作为观察组,选择同期无器质性心脏病且心电图正常的健康体检者88例作为对照组。随访1个月统计观察组发生 MAE 情况,并比较术前、术后 QTC 间期、Tp-ec 间期及 Tp-e/ QT 测定值；将 STR、QTc 间期、Tp-ec 间期、Tp-e/ QT 不同节点值发生 MAE 的例数及MAE 发生的危险因素变量代入 Cox 进行多因素回归校正分析。结果本观察组共发生 MAE 64例。观察组术前梗死及非梗死相关导联 QTc 间期、Tp-ec 间期、Tp-e/ QT 比较及与对照组比较差异均有统计学意义（P <0．05)；术后1周、1个月时 Tp-ec 间期和 Tp-e/ QT 较前一时段相同导联减小（P <0．05),且非梗死相关导联均小于梗死相关导联（P <0．05),非梗死相关导联 Tp-ec 间期在术后 1个月时恢复,其他均未恢复至正常水平（P <0．05),而 QTc 间期在术后1周各导联就已恢复至正常水平（P >0．05)。 Cox 多因素回归分析示：QTc 间期≥440 ms、Tp-ec 间期≥100 ms、Tp-e/ QT≥0．25是 STEMI患者 PCI 术后 MAE 发生的高风险因素。结论 STR、Tp-ec 间期、Tp-e/ QT 是 STEMI 患者 PCI 术后发生 MAE 的独立预测因素,可指导临床诊断和治疗。
目的：探討經皮冠狀動脈（冠脈)介入術（PCI)後 ST 段迴落幅度（STR)、Tp-ec 間期和 Tp-e/ QT 比值變化與急性 ST 段抬高型心肌梗死（ST segment elevation myocardial infarction, STEMI)後噁性心律失常事件（malignant arrhyth-mia events, MAE)的關繫。方法選擇我院經冠脈造影確診併在12 h 內行 PCI 治療的92例 STEMI 作為觀察組,選擇同期無器質性心髒病且心電圖正常的健康體檢者88例作為對照組。隨訪1箇月統計觀察組髮生 MAE 情況,併比較術前、術後 QTC 間期、Tp-ec 間期及 Tp-e/ QT 測定值；將 STR、QTc 間期、Tp-ec 間期、Tp-e/ QT 不同節點值髮生 MAE 的例數及MAE 髮生的危險因素變量代入 Cox 進行多因素迴歸校正分析。結果本觀察組共髮生 MAE 64例。觀察組術前梗死及非梗死相關導聯 QTc 間期、Tp-ec 間期、Tp-e/ QT 比較及與對照組比較差異均有統計學意義（P <0．05)；術後1週、1箇月時 Tp-ec 間期和 Tp-e/ QT 較前一時段相同導聯減小（P <0．05),且非梗死相關導聯均小于梗死相關導聯（P <0．05),非梗死相關導聯 Tp-ec 間期在術後 1箇月時恢複,其他均未恢複至正常水平（P <0．05),而 QTc 間期在術後1週各導聯就已恢複至正常水平（P >0．05)。 Cox 多因素迴歸分析示：QTc 間期≥440 ms、Tp-ec 間期≥100 ms、Tp-e/ QT≥0．25是 STEMI患者 PCI 術後 MAE 髮生的高風險因素。結論 STR、Tp-ec 間期、Tp-e/ QT 是 STEMI 患者 PCI 術後髮生 MAE 的獨立預測因素,可指導臨床診斷和治療。
목적：탐토경피관상동맥（관맥)개입술（PCI)후 ST 단회락폭도（STR)、Tp-ec 간기화 Tp-e/ QT 비치변화여급성 ST 단태고형심기경사（ST segment elevation myocardial infarction, STEMI)후악성심률실상사건（malignant arrhyth-mia events, MAE)적관계。방법선택아원경관맥조영학진병재12 h 내행 PCI 치료적92례 STEMI 작위관찰조,선택동기무기질성심장병차심전도정상적건강체검자88례작위대조조。수방1개월통계관찰조발생 MAE 정황,병비교술전、술후 QTC 간기、Tp-ec 간기급 Tp-e/ QT 측정치；장 STR、QTc 간기、Tp-ec 간기、Tp-e/ QT 불동절점치발생 MAE 적례수급MAE 발생적위험인소변량대입 Cox 진행다인소회귀교정분석。결과본관찰조공발생 MAE 64례。관찰조술전경사급비경사상관도련 QTc 간기、Tp-ec 간기、Tp-e/ QT 비교급여대조조비교차이균유통계학의의（P <0．05)；술후1주、1개월시 Tp-ec 간기화 Tp-e/ QT 교전일시단상동도련감소（P <0．05),차비경사상관도련균소우경사상관도련（P <0．05),비경사상관도련 Tp-ec 간기재술후 1개월시회복,기타균미회복지정상수평（P <0．05),이 QTc 간기재술후1주각도련취이회복지정상수평（P >0．05)。 Cox 다인소회귀분석시：QTc 간기≥440 ms、Tp-ec 간기≥100 ms、Tp-e/ QT≥0．25시 STEMI환자 PCI 술후 MAE 발생적고풍험인소。결론 STR、Tp-ec 간기、Tp-e/ QT 시 STEMI 환자 PCI 술후발생 MAE 적독립예측인소,가지도림상진단화치료。
Objective To explore the value of the elevated ST segment resolution (STR), Tp-ec (correction of T wave peak to the time) intermediate stage and Tp-e/ QT ratio changes after percutaneous coronary intervention (PCI) in prediction of malignant arrhythmia induced by acute ST segment elevation myocardial infarction (STEMI). Methods A total of 92 patients with STEMI confirmed by coronary angiography and undergoing PCI therapy within 12 h were selected as observation group, and 88 healthy controls with normal ECG at the same period were chosen as control group. The incidence rate of MAE in observation group was observed within one month of follow-up, and the values of intermediate stages of QTC and Tp-ec and Tp-e/ QT before and after operation were compared; Cox multiple factor regression of correction analysis was performed with numbers of MAE pa-tients in different nodes of intermediate stages of STR, QTc, Tp-ec, and Tp-e/ QT, and risk factors affecting incidence rate of MAE. Results Sixty-four patients had MAE in observation group. The differences in values of QTc, Tp-ec and Tp-e/ QT radio before the operation between related lead with infarction and non-infarction in observation group, and compared with those in control group (P <0. 05), the values of Tp-ec and Tp-e/ QT radio 1 week and 1 month after the operation were decreased, com-pared with the previous period of the same lead (P <0. 05), and the values of non-infarction lead were lower than those of in-farction lead (P <0. 05); non-infarction lead Tp-ec value returned to normal in postoperative 1 month (P <0. 05), but other in-dexes did not return to normal, while the lead values of QTc in postoperative 1 week had returned to normal (P > 0. 05) Cox multiple factor regression analysis showed that the high risk factors of MAE for STEMI patients after PCI operation were QTc≥440 ms, Tp-ec ≥100 ms and Tp-e/ QT ≥0. 25. Conclusion STR, Tp-ec and Tp-e/ QT radio are independent predictors of MAE onset in STEMI patients after PCI therapy, which is valuable for the clinical diagnosis and treatment.
