CAJ | 학술논문

目的：探讨急性ST段抬高型心肌梗死（ STEMI）患者行急诊经皮冠状动脉介入（ PCI）术后早期ST段变化的临床意义。方法2011年4月—2013年4月选取在北京大学航天临床医学院住院行急诊 PCI术的48例急性STEMI患者。根据PCI术后60 min内ST段回落情况将患者分为回落组（ ST段回落≥50%）和非回落组（ ST段回落<50%）。比较两组患者基本信息（包括性别、年龄、病史、生化指标、临床检查等）、ST段回落情况和手术资料〔发病时间、痛门时间、门球时间、手术时间、术后60 min后ST段抬高发生率、术后心肌梗死溶栓治疗（ TIMI）血流分级<3级发生率、单支病变发生率、两支病变发生率、三支病变发生率、左前降支（ LAD ）病变发生率、左回旋支（ LCX）病变发生率、右冠状动脉（ RCA）病变发生率〕、PCI术前左心室造影心脏参数〔左心室射血分数（ LVEF）、室壁异常运动节段数〕和出院前心脏超声心脏参数〔舒张末期容积（ EDV）、LVEF、E峰与A峰流速比值（ E/A）〕、出院后1年心血管事件发生率并进行生存分析。结果患者中回落组28例，非回落组20例。两组患者男性比例、Killip分级（≥2级）、年龄、心率（HR）、肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）比较，差异有统计学意义（ P<0.05）。PCI术后60 min内心电图示：回落组28例患者ST段回落，非回落组20例患者未出现ST段回落。两组患者PCI术后60 min后ST段抬高发生率、PCI术后TIMI血流分级<3级发生率比较，差异有统计学意义（ P<0.05）。PCI术前左心室造影示：两组患者LVEF、室壁异常运动节段数比较，差异无统计学意义（ P>0.05）。出院前心脏超声示：回落组患者LVEF高于非回落组，EDV低于非回落组（ P<0.05）；两组患者E/A比较，差异无统计学意义（ P>0.05）。回落组患者心律失常事件发生率、心力衰竭事件发生率、主要不良心脏事件（ MACE）发生率均低于非回落组（P<0.05）；两组患者心肌梗死后心绞痛事件发生率比较，差异无统计学意义（P>0.05）。回落组心律失常事件累计发生率、心力衰竭事件累计发生率、心肌梗死后心绞痛事件累计发生率、MACE累计发生率及复合心血管事件累计发生率均低于非回落组（χ2=32.643、30.643、33.296、4.023、30.468，P =0.001）。结论早期 ST 段回落的急性STEMI患者1年心血管事件累积发生率较低，能较好预测其近期预后，且早期ST段回落时间均在30 min内，为临床进一步研究提供参考。目的：探討急性ST段抬高型心肌梗死（ STEMI）患者行急診經皮冠狀動脈介入（ PCI）術後早期ST段變化的臨床意義。方法2011年4月—2013年4月選取在北京大學航天臨床醫學院住院行急診 PCI術的48例急性STEMI患者。根據PCI術後60 min內ST段迴落情況將患者分為迴落組（ ST段迴落≥50%）和非迴落組（ ST段迴落<50%）。比較兩組患者基本信息（包括性彆、年齡、病史、生化指標、臨床檢查等）、ST段迴落情況和手術資料〔髮病時間、痛門時間、門毬時間、手術時間、術後60 min後ST段抬高髮生率、術後心肌梗死溶栓治療（ TIMI）血流分級<3級髮生率、單支病變髮生率、兩支病變髮生率、三支病變髮生率、左前降支（ LAD ）病變髮生率、左迴鏇支（ LCX）病變髮生率、右冠狀動脈（ RCA）病變髮生率〕、PCI術前左心室造影心髒參數〔左心室射血分數（ LVEF）、室壁異常運動節段數〕和齣院前心髒超聲心髒參數〔舒張末期容積（ EDV）、LVEF、E峰與A峰流速比值（ E/A）〕、齣院後1年心血管事件髮生率併進行生存分析。結果患者中迴落組28例，非迴落組20例。兩組患者男性比例、Killip分級（≥2級）、年齡、心率（HR）、肌痠激酶（CK）、肌痠激酶同工酶（CK-MB）比較，差異有統計學意義（ P<0.05）。PCI術後60 min內心電圖示：迴落組28例患者ST段迴落，非迴落組20例患者未齣現ST段迴落。兩組患者PCI術後60 min後ST段抬高髮生率、PCI術後TIMI血流分級<3級髮生率比較，差異有統計學意義（ P<0.05）。PCI術前左心室造影示：兩組患者LVEF、室壁異常運動節段數比較，差異無統計學意義（ P>0.05）。齣院前心髒超聲示：迴落組患者LVEF高于非迴落組，EDV低于非迴落組（ P<0.05）；兩組患者E/A比較，差異無統計學意義（ P>0.05）。迴落組患者心律失常事件髮生率、心力衰竭事件髮生率、主要不良心髒事件（ MACE）髮生率均低于非迴落組（P<0.05）；兩組患者心肌梗死後心絞痛事件髮生率比較，差異無統計學意義（P>0.05）。迴落組心律失常事件纍計髮生率、心力衰竭事件纍計髮生率、心肌梗死後心絞痛事件纍計髮生率、MACE纍計髮生率及複閤心血管事件纍計髮生率均低于非迴落組（χ2=32.643、30.643、33.296、4.023、30.468，P =0.001）。結論早期 ST 段迴落的急性STEMI患者1年心血管事件纍積髮生率較低，能較好預測其近期預後，且早期ST段迴落時間均在30 min內，為臨床進一步研究提供參攷。
목적：탐토급성ST단태고형심기경사（ STEMI）환자행급진경피관상동맥개입（ PCI）술후조기ST단변화적림상의의。방법2011년4월—2013년4월선취재북경대학항천림상의학원주원행급진 PCI술적48례급성STEMI환자。근거PCI술후60 min내ST단회락정황장환자분위회락조（ ST단회락≥50%）화비회락조（ ST단회락<50%）。비교량조환자기본신식（포괄성별、년령、병사、생화지표、림상검사등）、ST단회락정황화수술자료〔발병시간、통문시간、문구시간、수술시간、술후60 min후ST단태고발생솔、술후심기경사용전치료（ TIMI）혈류분급<3급발생솔、단지병변발생솔、량지병변발생솔、삼지병변발생솔、좌전강지（ LAD ）병변발생솔、좌회선지（ LCX）병변발생솔、우관상동맥（ RCA）병변발생솔〕、PCI술전좌심실조영심장삼수〔좌심실사혈분수（ LVEF）、실벽이상운동절단수〕화출원전심장초성심장삼수〔서장말기용적（ EDV）、LVEF、E봉여A봉류속비치（ E/A）〕、출원후1년심혈관사건발생솔병진행생존분석。결과환자중회락조28례，비회락조20례。량조환자남성비례、Killip분급（≥2급）、년령、심솔（HR）、기산격매（CK）、기산격매동공매（CK-MB）비교，차이유통계학의의（ P<0.05）。PCI술후60 min내심전도시：회락조28례환자ST단회락，비회락조20례환자미출현ST단회락。량조환자PCI술후60 min후ST단태고발생솔、PCI술후TIMI혈류분급<3급발생솔비교，차이유통계학의의（ P<0.05）。PCI술전좌심실조영시：량조환자LVEF、실벽이상운동절단수비교，차이무통계학의의（ P>0.05）。출원전심장초성시：회락조환자LVEF고우비회락조，EDV저우비회락조（ P<0.05）；량조환자E/A비교，차이무통계학의의（ P>0.05）。회락조환자심률실상사건발생솔、심력쇠갈사건발생솔、주요불양심장사건（ MACE）발생솔균저우비회락조（P<0.05）；량조환자심기경사후심교통사건발생솔비교，차이무통계학의의（P>0.05）。회락조심률실상사건루계발생솔、심력쇠갈사건루계발생솔、심기경사후심교통사건루계발생솔、MACE루계발생솔급복합심혈관사건루계발생솔균저우비회락조（χ2=32.643、30.643、33.296、4.023、30.468，P =0.001）。결론조기 ST 단회락적급성STEMI환자1년심혈관사건루적발생솔교저，능교호예측기근기예후，차조기ST단회락시간균재30 min내，위림상진일보연구제공삼고。
Objective To explore the significance of early ST -segment changes in STEMI patients after emergent percutaneous coronary intervention( PCI) . Methods The study enrolled 48 STEMI patients who underwent emergent PCI in Peking University Aerospace School of Clinical Medicine from April 2011 to April 2013. According to ST -segment resolution within 60 minutes after PCI,the subjects were divided into resolution group( ST - segment resolution≥50%)and non -resolution group(ST-segment resolution<50%). Comparison was made between the two groups in basic information(gender, age,medical history,biochemical criterion and clinical examination),ST -segment resolution,operation data( onset time, pain-gate time,gate -ball time,operation time and the incidence rates of ST -segment resolution within 60 minutes after operation,postoperative TIMI blood flow <grade 3,single -vessel lesion,two -vessel lesion,three -vessel lesion,LAD lesion,LCX lesion and RCA lesion),preoperative left ventriculography parameters( LVEF and the number of segments with abnormal wall motion),echocardiographic parameters before discharge( EDV,LVEF and E/A)and the incidence of one-year cardiovascular events after discharge. And survival analysis was made based on the above data. Results There were 28 patients in resolution group and 20 patients in non - resolution group. The two groups were significantly different( P <0. 05 ) in male proportion,Killip grading(≥grade 2),age,heart rate( HR),creatine kinase( CK)and CK-MB. The electrocardiogram at 60 minutes after PCI showed that ST -segment resolution occurred in the 28 patients of resolution group and ST -segment resolution didn't occur in the 20 patients of non-resolution group. The two groups were significantly different(P<0. 05)in the incidence of ST-segment elevation within 60 minutes after PCI and the incidence of postoperative TIMI blood flow<grade 3. The preoperative left ventriculography showed that the two groups were not significantly different(P>0. 05)in LVEF and the number of segments with abnormal wall motion. The echocardiography before discharge showed that the resolution group was higher( P<0. 05)in LVEF and was lower(P<0. 05)in EDV than non-resolution group;the two groups were not significantly different in E/A(P>0. 05). The resolution group was lower(P<0. 05)than non-resolution group in the incidence rates of arrhythmia, heart failure and MACE;the two groups were not significantly different( P >0. 05 ) in the incidence rates of angina. The resolution group was lower than non-resolution group in the total incidence rates of malignant arrhythmia,heart failure,angina following myocardial infarction,major adverse cardiovascular events and composite cardiovascular events(χ2 =32. 643,30. 643, 33. 296,4. 023,30. 468;P = 0. 001 ). Conclusion The STEMI patients with early ST - segment resolution have lower incidence of total cardiovascular events,by which the short-term prognosis of STEMI patients can be well predicted,and the early ST-segment resolution usually occur within 30 minutes after PCI. And the finding may provide reference for further clinical research.