缺血分级对ST段抬高急性心急梗死患者心律失常的影响

目的探讨ST段抬高急性心急梗死（STEMI）患者心肌缺血分级对患者心律失常的影响。方法选取2009年6月～2011年5月未行溶栓治疗的STEMI患者76例，按心电图缺血分级分为Ⅱ级缺血组（36例）与Ⅲ级缺血组（40例）。比较两组患者入院时及溶栓2h后心电图ST段的变化，统计并比较室性早搏、室性心动过速或室颤、窦性停博及Ⅱ度或Ⅲ度房室传导阻滞等严重心律失常的发生率。结果患者人院时，Ⅱ级缺血组ST段抬高程度[（0．45±0．26）mVl明显低于Ⅲ级缺血组[（0．81±0．33）mV]，差异有统计学意义（t=5．242，P〈0．05）；Ⅲ级缺血组肌酸激酶同工酶（CK—MB）峰值[（370±67）U／L]高于Ⅱ级缺血组f（215±61）U／L]，差异有统计学意义（f=9．343，P〈0．05）。溶栓治疗2h后，Ⅱ级缺血组ST段抬高程度[（0．23±0．11）mVl、ST段回降一半及以上比例[80．6％（29／36）1、CK—MB峰值[（227±58）U／L]均优于Ⅲ级缺血组[（0．49±0．17）mV、57．5％（23／40）、（358±94）U／L1，差异有统计学意义（P〈0．05）。Ⅱ级缺血组与Ⅲ级缺血组在室性早搏f8_3％（3／36）、12．5％（5／40）1、室性心动过速或室颤[2．8％（1／36）、7．5％（3／40）]、窦性停博[0．0（0／36）、2．5％（1／40）]及1I度或Ⅲ度房室传导阻滞f2．8％（1／36）、5．0％（5／40）]等严重心律失常的发生率比较，均无统计学意义（P〉0．05）。Logistic回归分析结果显示，入院时心电图ST段抬高程度、发病至溶栓时间及Ⅲ级缺血是STEMI患者发生严重心律失常的独立危险因素（P〈0．05）。结论缺血分级对ST段抬高急性心急梗死患者心律失常具有预测价值。

Predictive significance of ischemia classification for arrhythmia in patients with ST-segment elevation acute myocardial infarction

Objective To investigate the influence of ischemia classification for arrhythmia in patients with ST-segment elevation acute myocardial infarction （STEMI）. Methods 76 cases of STEMI patients from June 2009 to May 2011 were selected and divided into grade Ⅱ ischemia group （36 cases） and grade m ischemia group （40 cases） through the ischemic electrocardiographic grade. ECG ST-segment changes were compared on admission and 2 hours after the thrombolysis in the two groups. The incidence of serious arrhythmias including premature ventricualr contraction, ventricular tachycardia or ventricular fibrillation, sinus arrest and Ⅱ or m degree atrioventricular block were recorded and compared. Results The degree of ST-segment elevation in grade 11 ischemia group [（0.45±0.26） mV] was lower than that in grade 11[ ischemia group [（0.81±0.33） mV] when patients admitted to hospital, the difference was statistically significant （t = 5.242, P 〈 0.05）; peak value of CK-MB in Ⅲ ischemia group [（370±67） U/L] was higher than that in I1 ischemia group [（215±61） U/L] when patients admitted to hospital, the difference was statistical- ly significant （t = 9.343, P 〈 0.05）. The degree of ST-segment elevation, ST segment proportion of falling back half or more, peak value of CK-MB in grade I1 ischemia group 2 hours after the thrombolysis [（0.23±0.11） mV, 80.6% （29/ 36）, （227±58） U/L] wei＇e all better than those in grade HI ischemia group [（0.49±0.17） mV, 57.5% （23/40）, （358±94） U/L], the differences were statistically significant （P 〈 0.05）. The differences of incidence of premature ventricualr con- traction [8.3%（3/36）, 12.5%（5/40）], ventricular taehycardia or ventricular fibrillation [2.8%（1/36）, 7.5%（3/40）], sinus arrest [0.0（0/36）, 2.5%（1/40）] and Ⅱ or m degree atrioventrieular block [2.8%（1/36）, 5.0%（5/40）] were not statistically significant （P 〉 0.05）. The degree of ST-segment elevation, the time from disease to thrombolysis, grade Ⅲischemia were the independent risk factors of severe anhythmia according to the Logistic regression analysis （P 〈 0.051）. Conthtsion Lschemic grade has predictive value in patients with ST-segment elevation acute myocardial intaretion and at-rhythmia.