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目的 :评价急性心肌梗死直接经皮冠状动脉腔内成形术 (PTCA)和支架置入术后ST段变化与心肌微血管灌注之间的关系 ,探讨ST段变化预测心肌微血管功能的可行性。方法 :测量PTCA和支架置入术前及术后 1、5、10、2 0、3 0min及 12h内相关导联ST段抬高指数 (∑STI)。术后 12h内行静脉心肌声学造影 (MCE)。根据心肌灌注将 2 4例患者分为无再流者 8例 (MCE积分为 3分或 2分 ) ,再流者 16例(MCE积分为 1分 )。MCE图像用MCE图像分析软件进行定量分析。结果 :心肌梗死相关动脉成功重建后 ,16例患者危险区有再流 ,8例出现无再流现象 ;再流者 16例患者中 ,14例∑STI下降≥ 5 0 % ,而在无再流者 8例中只有 1例 (P =0 0 0 0 1) ;无再流者 7例在术后 10min内∑STI进一步抬高≥3 0 % ,而再流者仅有 2例 (P =0 0 0 3 )。∑STI变化预测心肌微血管灌注敏感性、特异性及准确性均为 87 5 % ,阳性预测值为 93 3 % ,阴性预测值为 77 8%。术后 2 0min的∑STI与标化A·β值存在显著的负相关 (γ =-0 881,P =0 0 0 0 1)。结论 :急性心肌梗死成功再灌注治疗后不同的ST段变化与心肌微血管灌注有关 ;急性心肌梗死再灌注治疗后早期ST段变化可预测心肌微血管功能。
OBJECTIVE: To evaluate the relationship between ST segment changes and myocardial microvascular perfusion after direct percutaneous transluminal coronary angioplasty (PTCA) and stent implantation in acute myocardial infarction (AMI), and to investigate the feasibility of predicting myocardial microvascular function by ST segment changes. Methods: The ST segment elevation index (ΣSTI) of the relevant leads were measured before PTCA and stent implantation at 1, 5, 10, 20, 30 and 12 hours after operation. Intravenous myocardial contrast echocardiography (MCE) was performed within 12 hours after operation. According to myocardial perfusion, 24 patients were divided into no-reflow in 8 cases (MCE score of 3 or 2 points), re-flow in 16 cases (MCE score of 1 point). MCE images were quantitatively analyzed using MCE image analysis software. RESULTS: After successful reconstruction of the infarct-related artery, 16 patients had re-flow in the risk area and 8 patients had no reflow. Of the 16 patients who received reperfusion, 14 had a sig- nificant decrease in ΣSTI of ≥ 50% There was only 1 of 8 cases (P = 0 0 0 0 1). In 7 cases without reperfusion, ΣSTI was further elevated ≥ 30% within 10 minutes and only 2 cases of reperfusion 0 0 3). The sigma-STI changes of myocardial microvascular perfusion sensitivity, specificity and accuracy were 87.5%, positive predictive value of 93.3%, negative predictive value of 77.8%. There was a significant negative correlation between ΣSTI and normalized A · β values at 20 min after operation (γ = -0 881, P = 0 0 0 0 1). CONCLUSIONS: The changes of different ST segments following myocardial infarction-reperfusion therapy are related to myocardial microvascular perfusion. The changes of ST segment during early reperfusion after acute myocardial infarction can predict the myocardial microvascular function.