中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2014年
10期
15-18
,共4页
朱桂华%焦永春%张向东%李先维%唐璐
硃桂華%焦永春%張嚮東%李先維%唐璐
주계화%초영춘%장향동%리선유%당로
心肌梗塞%心律失常,心性%缺血%心电描记术
心肌梗塞%心律失常,心性%缺血%心電描記術
심기경새%심률실상,심성%결혈%심전묘기술
Myocardial infarction%Arrhythmias,cardiac%Ischemia%Electrocardiography
目的 探讨心肌缺血分级对急性ST段抬高型心肌梗死(STEMI)患者并发严重心律失常的预测价值.方法 选择急性STEMI患者225例,根据入院时心电图QRS波群形态进行心肌缺血分级并分组:Ⅱ级缺血组135例,Ⅲ级缺血组90例.两组患者在发病12 h内均行溶栓治疗,观察心电图ST段变化及住院期间严重心律失常的发生情况.结果 Ⅲ级缺血组人院时ST段抬高幅度(ΣST)大于Ⅱ级缺血组[(0.84±0.57) mV比(0.44±0.35) mV],溶栓后2hΣST仍大于Ⅱ级缺血组[(0.50±0.23) mV比(0.11±0.06) mV],差异均有统计学意义(P＜0.01).Ⅲ级缺血组溶栓后2hST段回降≥50％的比例低于Ⅱ级缺血组[56.7％(51/90)比83.7％(113/135)],差异有统计学意义(P＜0.01).Ⅲ级缺血组肌酸激酶同工酶MB (CK-MB)峰值高于Ⅱ级缺血组[(363±105) U/L比(212±97) U/L],差异有统计学意义(P＜0.01).Ⅲ级缺血组严重心律失常的发生率为18.9％(17/90),高于Ⅱ级缺血组的11.1％(15/135),但差异无统计学意义(P＞0.05).多元Logistic回归分析显示,发病至溶栓时间、入院时ΣST、Ⅲ级缺血是急性STEMI患者发生严重心律失常的独立预测因素,而Ⅲ级缺血的预测意义最强(OR=0.185,P=0.000).结论 急性STEMI患者入院时心电图呈Ⅲ级缺血,溶栓后易出现ST段回降不良,是发生严重心律失常的独立预测因素.
目的 探討心肌缺血分級對急性ST段抬高型心肌梗死(STEMI)患者併髮嚴重心律失常的預測價值.方法 選擇急性STEMI患者225例,根據入院時心電圖QRS波群形態進行心肌缺血分級併分組:Ⅱ級缺血組135例,Ⅲ級缺血組90例.兩組患者在髮病12 h內均行溶栓治療,觀察心電圖ST段變化及住院期間嚴重心律失常的髮生情況.結果 Ⅲ級缺血組人院時ST段抬高幅度(ΣST)大于Ⅱ級缺血組[(0.84±0.57) mV比(0.44±0.35) mV],溶栓後2hΣST仍大于Ⅱ級缺血組[(0.50±0.23) mV比(0.11±0.06) mV],差異均有統計學意義(P＜0.01).Ⅲ級缺血組溶栓後2hST段迴降≥50％的比例低于Ⅱ級缺血組[56.7％(51/90)比83.7％(113/135)],差異有統計學意義(P＜0.01).Ⅲ級缺血組肌痠激酶同工酶MB (CK-MB)峰值高于Ⅱ級缺血組[(363±105) U/L比(212±97) U/L],差異有統計學意義(P＜0.01).Ⅲ級缺血組嚴重心律失常的髮生率為18.9％(17/90),高于Ⅱ級缺血組的11.1％(15/135),但差異無統計學意義(P＞0.05).多元Logistic迴歸分析顯示,髮病至溶栓時間、入院時ΣST、Ⅲ級缺血是急性STEMI患者髮生嚴重心律失常的獨立預測因素,而Ⅲ級缺血的預測意義最彊(OR=0.185,P=0.000).結論 急性STEMI患者入院時心電圖呈Ⅲ級缺血,溶栓後易齣現ST段迴降不良,是髮生嚴重心律失常的獨立預測因素.
목적 탐토심기결혈분급대급성ST단태고형심기경사(STEMI)환자병발엄중심률실상적예측개치.방법 선택급성STEMI환자225례,근거입원시심전도QRS파군형태진행심기결혈분급병분조:Ⅱ급결혈조135례,Ⅲ급결혈조90례.량조환자재발병12 h내균행용전치료,관찰심전도ST단변화급주원기간엄중심률실상적발생정황.결과 Ⅲ급결혈조인원시ST단태고폭도(ΣST)대우Ⅱ급결혈조[(0.84±0.57) mV비(0.44±0.35) mV],용전후2hΣST잉대우Ⅱ급결혈조[(0.50±0.23) mV비(0.11±0.06) mV],차이균유통계학의의(P＜0.01).Ⅲ급결혈조용전후2hST단회강≥50％적비례저우Ⅱ급결혈조[56.7％(51/90)비83.7％(113/135)],차이유통계학의의(P＜0.01).Ⅲ급결혈조기산격매동공매MB (CK-MB)봉치고우Ⅱ급결혈조[(363±105) U/L비(212±97) U/L],차이유통계학의의(P＜0.01).Ⅲ급결혈조엄중심률실상적발생솔위18.9％(17/90),고우Ⅱ급결혈조적11.1％(15/135),단차이무통계학의의(P＞0.05).다원Logistic회귀분석현시,발병지용전시간、입원시ΣST、Ⅲ급결혈시급성STEMI환자발생엄중심률실상적독립예측인소,이Ⅲ급결혈적예측의의최강(OR=0.185,P=0.000).결론 급성STEMI환자입원시심전도정Ⅲ급결혈,용전후역출현ST단회강불량,시발생엄중심률실상적독립예측인소.
Objective To evaluate clinical significance of ischemia grade to predict severe arrhythmia in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 225 patients with STEMI admitting to emergency department were enrolled.All enrolled patients were divided into two groups based on the QRS complex electrocardiogram on admission:grade 1Ⅱ ischemia group(135 cases) and grade Ⅲ ischemia group (90 cases).All patients received thrombolytic therapy.The incidence rate of ST segment resolution (STR) and severe arrhythmia in hospital stay was observed.Results The ST segment elevation (Σ.ST) on admission and 2 h after thrombolysis in grade Ⅲ ischemia group was significantly higher than that in grade Ⅱ ischemia group [(0.84 ± 0.57) mV vs.(0.44 ± 0.35) mV,(0.50 ± 0.23) mV vs.(0.11 ± 0.06) mV] (P ＜ 0.01).The backing rate of ST segment ≥ 50％ 2 h after thrombolysis in grade Ⅲ ischemia group was significantly lower than that in grade Ⅱ ischemia group [56.7％ (51/90) vs.83.7％ (113/135)] (P ＜0.01).The creatine kinase MB (CK-MB) peak value in grade Ⅲ ischemia group was significantly higher than that in grade Ⅱ ischemia group [(363 ± 105) U/L vs.(212 ± 97) U/L] (P ＜ 0.01).There was no significant difference in the incidence of severe arrhythmia between two groups (P ＞ 0.05).Multiple Logistic regression analysis demonstrated that the independent predictors of severe arrhythmia were duration from symptom to thrombolysis and initial ΣST,whereas grade Ⅲ ischemia remained a strong predictor of severe arrhythmia.Conclusion Grade m ischemia on admission is associated with lower incidence of STR in patients with STEMI after thrombolysis and a strong predictor of severe arrhythmia.
