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目的探讨急性ST段抬高性心肌梗死(STEMI)直接经皮穿刺冠状动脉成形术(PCI)术后梗死相关动脉(IRA)完全开通、前向血流恢复后,早期ST段变化的临床意义。方法回顾性分析2001-01~12北京朝阳医院心脏中心收治的216例直接PCI后、IRA完全开通、前向血流恢复正常病人的临床、冠脉造影和心电图资料。直接PCI术后,ST段抬高指数≥50%的病人41例,为病例组。从其余175例ST段抬高指数<50%的病人中随机抽取50例,为对照组。结果两组病人的ST段抬高指数、Q波计数、室壁运动积分和平均肌酸激酶值差异有显著性意义(P<0·05);术后2周,ST段早期恢复较ST段持续抬高病人的室壁运动改善,左室射血分数(LVEF)、心排指数(CI)、每搏指数(SVI)增加(P<0·05)。ST段早期恢复合并心功能不全的病人,术后2周室壁运动增强,LVEF、CI、SVI增加(P<0·05),左室舒张末容积、左室收缩末容积减少(P<0·01)。结论STEMI直接PCI后IRA完全开通、前向血流恢复正常而ST段持续抬高病人的梗死范围扩大,左室舒缩功能不全严重,可能与心肌组织没有有效地恢复血流灌注或无复流有关。
Objective To investigate the clinical significance of the early stages of ST segment changes after the complete occlusion of the infarct-related artery (IRA) in patients with acute ST-elevation myocardial infarction (STEMI) and direct percutaneous transluminal coronary angioplasty (PCI). Methods A retrospective analysis of 216 PCI patients admitted to Beijing Chaoyang Hospital from January 2001 to December 12 was performed. The IRA was completely switched on, and the anterior blood flow was recovered to the clinical, coronary angiographic and electrocardiographic data of normal patients. After direct PCI, 41 patients with ST segment elevation index≥50% were the case group. From the remaining 175 patients with ST-segment elevation index <50%, 50 patients were randomly selected as the control group. Results There were significant differences in ST segment elevation index, Q wave count, wall motion score and average creatine kinase between the two groups (P <0.05). After 2 weeks, the recovery of ST segment was earlier than that of ST segment LVEF, CI and SVI (P <0.05) were improved in patients with sustained elevation of ventricular wall motion. In patients with early recovery of ST segment and heart failure, wall motion increased, LVEF, CI, SVI increased (P <0.05), left ventricular end-diastolic volume and left ventricular end-systolic volume decreased · 01). Conclusions The IRA of STEMI is completely opened after direct PCI. The infarction size of patients with normal antegrade blood flow and persistent elevation of ST segment enlargement, and the left ventricular systolic and diastolic dysfunction is serious, which may not be related to myocardial tissue recovery of perfusion or no-reflow related.