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目的：探讨急性心肌梗死（AMI）溶栓治疗（TT）后ST段变化及其临床意义。方法：连续观察182例AMI患者TT3h的ST段变化，根据TT后3hST段回降程度分为完全回降组（≥70％）、部分回降组（30％～70％）、未回除组（＜30％或反而升高），比较三组血管再通率、心功能、再梗死率及一周死亡率。结果：1）TT后＜3h少数病例（7．14％）ST段有暂时再发性抬高或持续性再发性抬高；2）三组再通率分别是77．50％、40．91％、13．89％（P＜0．01）；3）三组发生心功能KillipⅣ分别为1．25％、3．03％、22．22％（P＜0．01）；4）三组再梗死率分别为2．50％、1．52％、2．78（P＞0．05）；5）一周死亡率三组分别是1．25％、10．61％、33．33％（P＜0．01）。结论：AMI溶栓时要连续监护ST段移位；TT早期ST段有波动，以＜3hST段为判定指标时可导致错误结论；TT后3hST段完全回降提示冠脉再通，预后良好；ST段未回降或反而持续抬高者，暗示冠脉闭塞，预告早期死亡。
Objective: To investigate the changes of ST segment after thrombolytic therapy (TT) in acute myocardial infarction (AMI) and its clinical significance. Methods: The ST segment changes in TT3h of 182 patients with AMI were observed continuously. According to the degree of fall in 3h ST after TT, the levels of ST segment changes were classified as complete descending group (≥70%), partial descending group (30% ~ 70%), (<30% or increased). The rate of revascularization, cardiac function, reinfarction and one-week mortality were compared between the three groups. Results: 1) The ST segment of a few cases (7.14%) with TT <3h had transient or persistent recurrent elevation; 2) The recanalization rates of the three groups were 77.50% and 40% respectively. 91% and 13.89%, respectively (P <0.01); 3) Killip Ⅳ of cardiac function in three groups were 1.25%, 3.03% and 22.22% The rates of reinfarction were 2.50%, 1.52% and 2.78 respectively (P> 0.05). 5) The three-week mortality rates were 1.25%, 10.61% and 33.33% (P <0.01). CONCLUSIONS: ST segment displacement should be monitored continuously during thrombolytic therapy of AMI. ST segment of early TT fluctuates. When <3 hST segment is used as a criterion, it may lead to wrong conclusions. Complete withdrawal of 3 h ST segment may lead to coronary recanalization with good prognosis. ST segment did not fall back or sustained elevation, suggesting coronary occlusion, early warning of death.