急性心肌梗死介入治疗近中期疗效和相关因素分析

目的分析ST段抬高的急性心肌梗死(AMI)与下移者介入治疗的近中期疗效与预后方面的因素。方法病例来自我科2001～2004-12间收治并经介入治疗的AMI病人,根据心电图ST段是否抬高分组,对患者的一般情况及危险因素(高血压、糖尿病、高血脂)及治疗结果(包括术后心脏功能指标、冠脉血流分级、随访期间病死率、非致死性梗死、再住院率及再次血管重建率)等进行对比分析。结果两组病例比较:ST段抬高组年龄明显低于下移组,分别为(55.43±12.34)岁和(73.45±7.25)岁,P<0.05;性别组间无明显差异,P>0.05;危险因素比较:ST段抬高组糖尿病比例明显少于下移组:(45.28%)∶(64.58%),P<0.05;高血压病两组无明显差异:(77.36%)∶(89.58%),P>0.05;LDL∶ST段抬高组明显高于下移组:(5.31±0.22)∶(4.25±0.17),P<0.05;HDL:两组无明显差异:(1.10±0.11)∶(1.24±0.10),P>0.05;造影结果:ST段抬高组多支病变明显少于下移组:(45%)∶(67%),P<0.05;介入治疗手术成功率无明显差异:(98%)∶(94%),P>0.05;随访时间无明显差异:(22.77±8.55)个月比(20.91±7.79)个月,P>0.05;治疗后靶血管获得血流(TIMI)ST段抬高组较好:(2.84)∶(2.45),P<0.05;心脏事件:ST段抬高组非致死性AMI明显少于下移组:(5.6%)∶(19%),P<0.05;住院率无明显差异:(26.4%)∶(27%),P>0.05;CABG及再次介入治疗两组间无明显差异:(5.6%)∶(8.3%),P>0.05;ST段下移组死亡率明显高于抬高组:(9%)∶(17%),P>0.05;ST段抬高组LVEF优于ST段下移组:术后1周(0.49±0.11);1个月:(0.51±0.10)∶(0.42±0.12),P<0.95。结论ST下移的心肌梗死多支病变明显增多,年龄和糖尿病是其重要影响因素,高血压与其无明显关系;ST段下移的心肌梗死术后心脏功能较差,冠脉血流HDL明显慢,病死率高,心脏事件无明显差异;血脂水平LDL可能是较低年龄心肌梗死的危险因素,而在高龄组可能影响不大;ST下移的心肌梗死预后较差。

Analysis on Mid-term Curative Effect and Relative Factor on Interventional Treatment of AMI

Objective To analyze the varied methods in ST changes of AMI patient in diagnosis, treatment and prevention. Methods The clinical materials of interventional treated AMI patient from 2001 to 2004 were analyzed in general situation, risk factor and curative results retrospectively. Results There were no significant difference between two groups in sex, hypertension, HDL, hospitalization and successful rate of interventional operation. There were lower in age, risk factor, LDL angiography result, cardiac accident and mortality in ST elevated group than those in decreased ST group. Conclusion The risk factors in ST segment decreased group might be age, diabetes, LDL with multi branches lesion. The prognosis of this group in AMI might be poor.