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目的:探讨前壁急性心肌梗死(AMI)墓碑型心电图改变患者临床、冠状动脉病变特点及急诊冠状动脉介入治疗(PCI)的效果。方法:接受急诊PCI的前壁AMI患者102例,根据心电图特点,分为墓碑组(31例)和非墓碑组(71例),对比分析其临床、冠状动脉病变特点、即刻手术成功率和住院期间主要心脏事件的发生情况。结果:墓碑组梗死前心绞痛比例明显低于非墓碑型组(P<0.01)。墓碑组犯罪病变多位于左前降支(LAD)近端(64.5%∶36.6%,P<0.01),并发右冠状动脉和左回旋支病变的比例高(51.6%∶21.1%,P<0.01;38.7%∶17.0%,P<0.01),术前TIMI血流分级0~1级比例明显高于非墓碑组(83.9%∶59.1%,P<0.05),墓碑组发病-球囊开通时间明显短于非墓碑组[(5.3±5.5)h∶(7.4±6.8)h,P<0.05]。2组术后TIMI血流分级、手术操作时间和手术成功率、术后2 h心电图ST段的回落程度、肌酸激酶同工酶峰值、左室射血分数及主要不良心脏事件的发生情况均差异无统计学意义(P>0.05)。结论:墓碑型前壁AMI患者犯罪病变多位于LAD近端且多为完全闭塞,常并发其他冠状动脉病变及缺乏良好的侧支循环保护,急诊PCI是安全、有效的,并能明显改善其预后。
Objective: To investigate the clinical characteristics of coronary artery lesions and the effect of emergency percutaneous coronary intervention (PCI) in patients with anterior wall acute myocardial infarction (AMI) tombstone-type electrocardiogram. Methods: One hundred and two patients with AMI in the anterior wall of patients undergoing PCI were divided into two groups according to their electrocardiographic features: tombstone group (31 cases) and non-tombstone group (71 cases). The clinical features, coronary artery lesions, immediate success rate and hospitalization Occurrence of major cardiac events during. Results: The proportions of pre-infarction angina in tombstone group were significantly lower than those in non-tombstone group (P <0.01). Most of the criminal cases in the tombstone group were located in the proximal LAD (64.5%, 36.6%, P <0.01), with high incidence of right coronary artery and left circumflex coronary artery lesions (51.6% vs 21.1%, P <0.01; 38.7 %: 17.0%, P <0.01). The preoperative TIMI grade 0-1 grade was significantly higher than non tombstone group (83.9%: 59.1%, P <0.05) Non-tombstone group [(5.3 ± 5.5) h: (7.4 ± 6.8) h, P <0.05]. TIMI flow classification, operation time and success rate of operation, postoperative 2 h ECG ST segment fall, the creatine kinase isoenzyme peak, left ventricular ejection fraction and the incidence of major adverse cardiac events were The difference was not statistically significant (P> 0.05). Conclusion: Most of the patients with AMI in the gravestone anterior wall are mostly located in the proximal LAD and are mostly occluded, often with other coronary lesions and lack of good collateral circulation protection. Emergency PCI is safe and effective and can significantly improve their prognosis .