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目的 :探讨直接经皮冠状动脉腔内球囊成形术 (PTCA)治疗急性心肌梗死(AMI)后心电图抬高的ST段的变化与临床预后的关系。方法 :10 8例成功行直接PTCA的AMI患者 ,分析术后 1h 12导联心电图抬高的ST段下移幅度 ,分为四组 :A组 :抬高ST段下移 10 0 % ;B组 :抬高ST段下移 5 0 %～ 10 0 % ;C组 :抬高ST段下移 0～ 5 0 % ;D组 :ST段无下移。结果 :四组梗死相关血管 (IRA)开通时间相似 ,A组患者下壁和 /或后壁、右室梗死占 84 6 % ,与其余三组比较均有显著性差异 (P <0 0 1～ 0 0 5 )。抬高ST段下降≥ 5 0 %组比 <5 0 %组的CPK、CK-MB峰值 ,梗死延展发生率及病死率明显下降 (分别为 32 6 6 1± 2 15 7 6比 436 4 0± 2 873 0 ,134 5± 80 1比 176 9± 10 7 5 ,0比 6 1% ,1 3%比 12 1% ,P <0 0 5 ) ,LVEF明显升高 (5 8 5±12 9比 5 1 5± 16 0 ,P <0 0 5 )。结论 :AMI成功再灌流治疗后抬高ST段下移幅度可作为判断预后的一个重要指标 ,迅速下降≥ 5 0 %组梗死面积小 ,左室收缩功能好 ,近期心脏事件发生率及病死率低。
Objective: To investigate the relationship between ST segment elevation and clinical prognosis after electrocardiogram elevation in patients undergoing direct percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction (AMI). Methods: A total of 108 patients with AMI who underwent direct PTCA were enrolled in this study. The extent of ST-segment elevation in 12-lead electrocardiogram at 1 hour after operation was analyzed and divided into four groups: group A: elevation of ST segment by 100%; group B : Raise ST segment down 50% ~ 100%; C group: raise ST segment down 0 ~ 50%; D group: ST segment without down. Results: The opening time of IRA in the four groups was similar. The inferior wall and / or posterior wall and right ventricular infarction in group A were 84.6%, which were significantly different from the other three groups (P <0.01 ~ 0 0 5). The CPK and CK-MB peak value, the incidence of infarction extension and the mortality rate were significantly decreased in ST segment depression ≥50% and <50% groups (32 6 6 ± 2 15 7 6 vs 436 4 0 ± 2 873 0,134 5 ± 80 1 vs 176 9 ± 10 7 5, 0 6 1%, 1 3% vs 12 1%, P 0 05), LVEF was significantly higher (58 5 ± 12 9 vs 5 1 5 ± 16 0, P <0 0 5). CONCLUSIONS: The extent of ST-segment elevation after successful reinfusion treatment in AMI can be used as an important index to judge the prognosis. The rapid decrease of ≥50% of the patients with small infarction size, good left ventricular systolic function, recent cardiac events and low mortality .