CAJ | 학술논문

目的通过观察ST段抬高型心肌梗死患者急诊血运重建术后ST段回复程度,分析ST段回复不全患者的临床特点.方法根据术后即刻心电图ST段回落率,将198例患者分为ST段回复完全组(ST段回落率≥50％)和ST段回复不全组(ST段回落率＜50％).对比观察两组患者临床特点、梗死相关血管特征及手术相关事项;记录住院及随访期间心血管事件(靶血管重建、再发心肌梗死或死亡).采用SPSS 10.0软件进行统计分析.结果 (1) ST段回复不全组中＞75岁患者明显多于ST段回复完全组(9例,21.4％ vs.14例,9.0％;P＜0.05);(2) ST段回复不全组总缺血时间长于回复完全组[(5.2±2.2)h vs.(3.0±1.6)h,P＜0.01],梗死相关动脉为LAD更为常见(27例,64.3％ vs.69例,44.2％;P＜0.05),术后冠脉造影IRA血流达TIMI3级者少于回复完全组(32例,76.2％ vs.140例,90％;P＜0.05).ST段回复不全患者中GPⅡb/Ⅲa受体拮抗剂应用率较低,应用IABP几率高于回复完全组(P＜0.01);(3)住院期间及随访心血管事件发生率比较,ST段回复不全组均高于回复完全组;(4)多因素分析:年龄＞75岁(OR=4.452)、LAD闭塞(OR =3.317)、总缺血时间(OR=1.897)是影响术后心电图ST段恢复的相关因素.结论行急诊血运重建的STEMI患者中高龄、LAD闭塞、缺血时间较长、术前未应用GPⅡb/Ⅲa受体拮抗剂的患者,易发生ST段回落不良且预后差.其中,年龄＞75岁、LAD闭塞及总缺血时间长是术后心电图ST段回落不良的预测因素.
목적 통과관찰ST단태고형심기경사환자급진혈운중건술후ST단회복정도,분석ST단회복불전환자적림상특점.방법 근거술후즉각심전도ST단회락솔,장198례환자분위ST단회복완전조(ST단회락솔≥50％)화ST단회복불전조(ST단회락솔＜50％).대비관찰량조환자림상특점、경사상관혈관특정급수술상관사항;기록주원급수방기간심혈관사건(파혈관중건、재발심기경사혹사망).채용SPSS 10.0연건진행통계분석.결과 (1) ST단회복불전조중＞75세환자명현다우ST단회복완전조(9례,21.4％ vs.14례,9.0％;P＜0.05);(2) ST단회복불전조총결혈시간장우회복완전조[(5.2±2.2)h vs.(3.0±1.6)h,P＜0.01],경사상관동맥위LAD경위상견(27례,64.3％ vs.69례,44.2％;P＜0.05),술후관맥조영IRA혈류체TIMI3급자소우회복완전조(32례,76.2％ vs.140례,90％;P＜0.05).ST단회복불전환자중GPⅡb/Ⅲa수체길항제응용솔교저,응용IABP궤솔고우회복완전조(P＜0.01);(3)주원기간급수방심혈관사건발생솔비교,ST단회복불전조균고우회복완전조;(4)다인소분석:년령＞75세(OR=4.452)、LAD폐새(OR =3.317)、총결혈시간(OR=1.897)시영향술후심전도ST단회복적상관인소.결론 행급진혈운중건적STEMI환자중고령、LAD폐새、결혈시간교장、술전미응용GPⅡb/Ⅲa수체길항제적환자,역발생ST단회락불량차예후차.기중,년령＞75세、LAD폐새급총결혈시간장시술후심전도ST단회락불량적예측인소.
Objective To survey ST-segment resolution in STEMI patients undergoing emergency percutaneous coronary intervention (PCI) and to find the specific clinical features of patients with inadequate ST-segment resolution.Methods A total of 198 patients were divided into two groups according to the ratio of ST-segment resolution:relatively adequate ST-segment resolution group (＞ 50％) and inadequate STsegment resolution group (＜ 50％).The clinical features,infarct-related artery and PCI-related evants were evaluated,and major adverse cardiovascular events (MACE including target vessel revascularization,recurrent myocardial infarction,or death) were recorded during hospitalization and follow-up period.Multivariate logistic analysis was used to identify relevant factors influencing ST-segment resolution of STEMI patients after treatment with PCI.The Statistical analyses of data were carried out using SPSS 10.0 software.Results (1) There were 156 patients with relativey adequate ST-segment resolution and 42 patients with inadequate ST-segment resolution.Of them,there were higher percentage of patients aged over 75years in the inadequate ST-segment resolution group than those in the relatively adequate ST-segment resolution group (9 cases,21.4％ vs.14 cases,9.0％ ; P ＜0.05).(2) In inadequate ST-segment resolution group,thetotal ischemic time was significant longer [(5.2 ±2.2) h vs.(3.0 ± 1.6) h,P ＜0.01].The infarctrelated artery (IRA) was more common at left anterior descending coronary artery (LAD) (27 cases,64.3％ vs.69 cases,44.2％; P ＜ 0.05) and there were fewer patients with TIM grade 3 of IRA in inadequate ST-segment resolution group after primary PCI than that in relative adequate ST-segment resolution group (32 cases,76.2％ vs.140 cases,89.7％ ; P ＜ 0.05).There was a lower rate of using GP Ⅱ b/Ⅲ a receptor antagonist and a higher rate of prescribing IABP in inadequate ST-segment resolution group.(3) There is a higher incidence of MACE during hospitalization and follow-up period in patients with inadequate ST-segment resolution.(4) Multivariate logistic analysis indicated that age over 75 years,LAD occlusion,the total ischemic time were related to ST-segment resolution.Conclusions The patients with age over 75 years,LAD occlusion,longer ischemia time,and unemployment GP Ⅱ b/Ⅲ a receptor antagonist before PCI were prone to get inadequate ST-segment resolution and poor prognosis.Age over 75 years,LAD occlusion,and longer ischemic time were independent risk factors of the inadequate ST-segment resolution in STEMI patients after emergency PCI.