CAJ | 학술논문

目的：探讨 ST段抬高型急性心肌梗死（acute ST segment elevation myocardial infarction，STEMI）患者心肌梗死面积、冠状动脉 Gensini积分与血钾水平的关系，指导治疗方案，制定临床决策，改善患者预后。方法选择行急诊经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）STEMI的患者128例，按照入院血清钾水平分为低于3．50 mmol／L、高于3．50 mmol／L 两组，监测其18导联心电图并记录 PCI冠状动脉病变结果，前壁根据Aldrich公式，下壁根据Clemmensen改良公式计算心肌梗死面积，运用 Gensini积分评价冠状动脉病变程度，同时记录患者住院期间心血管不良事件的发生情况。结果入选的 1 2 8例 STEMI 患者中，低血钾发生率为29．7％（38／128），其中广泛前壁 STEMI发生率最高42．1％（16／38），下壁累及后壁 STEMI发生率最低5．3％（2／38）；低钾组梗死面积小于20％者14例，20％～30％者14例，大于30％者10例，低钾组梗死面积明显高于血钾正常组，差异有统计学意义（P＜0．01）；低钾组冠状动脉 Gensini积分小于50分者6例，50～80分者12例，大于80分者20例，低钾组冠状动脉 Gensini积分明显高于血钾正常组，差异有统计学意义（P＜0．05）。血钾浓度与梗死面积、Gensini积分呈负相关（P＜0．01）。结论 STEMI患者中低钾血症发生与梗死面积、部位密切相关，多为前降支、近段病变．且梗死面积越大、冠状动脉病变程度越重越易出现低钾血症。将血钾控制在适当水平有助于预防并发症的发生，并能改善预后。
목적：탐토 ST단태고형급성심기경사（acute ST segment elevation myocardial infarction，STEMI）환자심기경사면적、관상동맥 Gensini적분여혈갑수평적관계，지도치료방안，제정림상결책，개선환자예후。방법선택행급진경피관상동맥개입치료（percutaneous coronary intervention，PCI）STEMI적환자128례，안조입원혈청갑수평분위저우3．50 mmol／L、고우3．50 mmol／L 량조，감측기18도련심전도병기록 PCI관상동맥병변결과，전벽근거Aldrich공식，하벽근거Clemmensen개량공식계산심기경사면적，운용 Gensini적분평개관상동맥병변정도，동시기록환자주원기간심혈관불량사건적발생정황。결과입선적 1 2 8례 STEMI 환자중，저혈갑발생솔위29．7％（38／128），기중엄범전벽 STEMI발생솔최고42．1％（16／38），하벽루급후벽 STEMI발생솔최저5．3％（2／38）；저갑조경사면적소우20％자14례，20％～30％자14례，대우30％자10례，저갑조경사면적명현고우혈갑정상조，차이유통계학의의（P＜0．01）；저갑조관상동맥 Gensini적분소우50분자6례，50～80분자12례，대우80분자20례，저갑조관상동맥 Gensini적분명현고우혈갑정상조，차이유통계학의의（P＜0．05）。혈갑농도여경사면적、Gensini적분정부상관（P＜0．01）。결론 STEMI환자중저갑혈증발생여경사면적、부위밀절상관，다위전강지、근단병변．차경사면적월대、관상동맥병변정도월중월역출현저갑혈증。장혈갑공제재괄당수평유조우예방병발증적발생，병능개선예후。
ABSTRACT:Objective To evaluate the relationship between the serum potassium level and the myocardial infarction area and coronary Gensini scores in patients with acute ST segment elevation myocardial infarction (STEMI),so as to guide the treatment,make clinical decisions and improve the prognosis of the patients.Methods A total of 128 patients with STEMI receiving primary percutaneous coronary intervention (PCI)in our hospital were enrolled in this study.According to the serum potassium level,the patients were divided into hypokalemia group (serum potassium ≤3.5 mmol/L)and normal potassium group (serum potassium >3.5 mmol/L).The 18 leading electrocardiogram (ECG)was carried out on each patient and the PCI results of each patient were recorded.Myocardial infarction area was calculated basing on the Aldrich and Clemmensen formula and Gensini scoring was used to evaluate the severity of coronary artery lesions.The adverse events of the patients were also recorded.Results The incidence of hypokalemia was 29.7% (38/128),among which the extensive anterior wall STEMI had the highest incidence 42.1%(16/38),and the inferior wall STEMI had the lowest incidence 5.3%(2/38).In the hypokalemia group,there were 14 patients with myocardial infarct area (MIA)less than 20%,14 patients with MIA between 20% and 30% and 10 patients with MIA more than 30%,significantly higher than the MIA in normal potassium group (P<0.01).In hypokalemia group,6 patients were with Gensini score lower than 50,12 patients with Gensini score between 50 and 80,and 20 with Gensini score more than 80,also remarkably higher than that in the normal group (P <0.05 ). Pearson correlation analysis showed that there were negative correlation between serum potassium,infarction area and Gensini scores (P<0.01).Conclusion The incidence of hypokalemia in STEMI patients is closely related to the infarction area and the infarction position,especially the infarction in anterior descending and proximal coronary artery. Thus,appropriate control of the potassium levels can be helpful for reducing the occurrence of complications and improving the prognosis of the patients.