CAJ | 학술논문

目的探讨急性前壁ST段抬高心肌梗死(STEMI)患者的心电图及心肌酶峰与左室功能的相关性.方法 2009年1月至2012年1月河北承德医学院附属医院心内科住院STEMI患者288例,其中前壁186例,符合纳入标准的138例均连续入选,收集患者的临床资料并随访梗死后3个月心功能.结果 STEMI患者的心电图前壁导联ST段抬高幅度之和(∑ST)、Q波之和(∑Q)以及Q波导联数,与Killip分级、心肌酶峰值、脑钠肽(BNP)、急性期/梗死后3个月的左室舒张末内径(LVEDD)正相关[γ,0.52 ～0.75,P＜0.01],但与急性期/梗死后3个月的左室射血分数(LVEF)负相关[γ,-0.63 ～-0.95,P＜0.01];前壁导联R波振幅之和(∑R),与心肌酶峰值、BNP、急性期/梗死后3个月LVEDD负相关[γ,-0.48 ～-0.79,P＜0.01],但与急性期/梗死后3个月LVEF正相关[γ,0.73 ～0.82,P＜0.01];前壁各导联ST段抬高最大值,与Killip分级、心肌酶峰值、BNP、急性期/梗死后3个月LVEDD正相关[γ,0.41 ～0.62,P＜0.05].Q波振幅最大值,与Killip分级、心肌酶峰值、BNP、急性期/梗死后3个月的LVEDD正相关[γ,0.42 ～0.64,P＜0.05].∑ST、ΣQ、ΣR和Q波导联数与梗死后3个月心功能无显著相关(P＞0.05).BNP与STEMI急性期/3个月LVEF呈强负相关[γ,-0.92、-0.80,P＜0.01].结论急性前壁STEMI心电图ST段、Q波、R波及心肌酶峰与左室功能呈强相关,可用于预测STEMI后近期心功能.
목적 탐토급성전벽ST단태고심기경사(STEMI)환자적심전도급심기매봉여좌실공능적상관성.방법 2009년1월지2012년1월하북승덕의학원부속의원심내과주원STEMI환자288례,기중전벽186례,부합납입표준적138례균련속입선,수집환자적림상자료병수방경사후3개월심공능.결과 STEMI환자적심전도전벽도련ST단태고폭도지화(∑ST)、Q파지화(∑Q)이급Q파도련수,여Killip분급、심기매봉치、뇌납태(BNP)、급성기/경사후3개월적좌실서장말내경(LVEDD)정상관[γ,0.52 ～0.75,P＜0.01],단여급성기/경사후3개월적좌실사혈분수(LVEF)부상관[γ,-0.63 ～-0.95,P＜0.01];전벽도련R파진폭지화(∑R),여심기매봉치、BNP、급성기/경사후3개월LVEDD부상관[γ,-0.48 ～-0.79,P＜0.01],단여급성기/경사후3개월LVEF정상관[γ,0.73 ～0.82,P＜0.01];전벽각도련ST단태고최대치,여Killip분급、심기매봉치、BNP、급성기/경사후3개월LVEDD정상관[γ,0.41 ～0.62,P＜0.05].Q파진폭최대치,여Killip분급、심기매봉치、BNP、급성기/경사후3개월적LVEDD정상관[γ,0.42 ～0.64,P＜0.05].∑ST、ΣQ、ΣR화Q파도련수여경사후3개월심공능무현저상관(P＞0.05).BNP여STEMI급성기/3개월LVEF정강부상관[γ,-0.92、-0.80,P＜0.01].결론 급성전벽STEMI심전도ST단、Q파、R파급심기매봉여좌실공능정강상관,가용우예측STEMI후근기심공능.
Objective To analyze the correlation between ST segment elevation,Q wave and peak biomarkers with left ventricular dysfunction in patients with acute anterior ST elevation myocardial infarction (STEMI).Methods A total of 138 consecutive inpatients with acute anterior STEMI,left anterior descending branch as the convict vessle,from January 2009 to January 2012 in our hospital were enrolled in this study.They were divided into reperfusion(n =92) and non-reperfusion group(n =46).Clinical data,electrocardiogram,peak biomarkers,type B natriuretic peptide(BNP) were collected by physicans and the patients were followed up three months.Results The sum of the ST segments elevation,Q waves and Q wave leads in anterior STEMI were positive correlation with the Killip grades,myocardium biomarkers,BNPand left ventricle end diastolic diameters(LVEDD) [γ,0.52-0.75,P ＜0.01],while negative correlation with left ventricle ejection fraction(LVEF) [γ,-0.63--0.95,P ＜ 0.01].The sum of R wave altitude was negative correlation with myocardium biomarkers,BNP and LVEDD in three months after the onset of STEMI [γ,-0.48--0.79,P ＜ 0.01],while positive correlation with LVEF [γ,0.73-0.82,P ＜ 0.01].BNP,one of the best markers of left heart dysfunction,was found to be strongly negative correlation with LVEF in acute stage and three months after the onset of STEMI [γ,-0.92,-0.80,P ＜ 0.01].Conclusion There are close correlations between electrocardiogram,myocardial biomarkers and left ventricular dysfunction in acute anterior ST segment elevation myocardial infarction,which may be strong predictors for the short-term prognosis.