摘要
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 in patients with acute myocardial infarction treated by direct angioplasty and stenting.To explore the feasibility of ST segment changes in predicting microvascular function. Methods:The sum of ST segment elevation index (∑STI,the sum of ST segment elevation divided by the number of leads involved)was measured before and at 1,5,10,20,30 minutes and 12 hours after successful direct angioplasty and stentins.Intravenous myocardial contrast echocardiography(MCE)was performed within 12 hours after successful direct angioplasty and stenting.Twenty four patients were classified into two groups according to the perfusion pattern on MCE:Eight patients with MCE score 3 or 2 were defined as no reflow group,and 16 patients with MCE score 1 were defined as reflow group.MCE pictures were quantitively analyzed by MCE analyzing software provided by Virginia University. Results:After infarction related artery successful recanalization,myocardial perfusion within the risk area was observed in 16 patients,whereas a no reflow phenomenon occurred in 8.In patients with reflow,the ∑STI rapidly declined,whereas in patients with no reflow,no significant change was observed.Reduction of ≥50% ∑STI occurred in 14 of 16 patients with reflow and in 1 of 8 with no reflow ( P =0 0001) An additional increase of ≥30% ∑STI occurred in 7 patients with no reflow within 10 minutes after recanalization and 2 with reflow ( P =0 003).Sensitivity,specificity,positive and negative predictive values,and accuracy of the ∑STI were 87 5%,87 5%,93 3%,77 8%,and 87 5%,respectively.The 20 minute ∑STI after recanalization was well negatively correlated with the normalized A·β value(γ=-0 881, P =0 0001). Conclusion:Different ST segment changes are associated with different patterns of myocardial perfusion.The ST segment changes can predict the microvascular function early after successful reperfusion therapy for AMI.
出处
《中国循环杂志》
CSCD
北大核心
2002年第3期177-179,共3页
Chinese Circulation Journal
