ST段早期恢复反映急性心肌梗死溶栓治疗后心肌再灌注

目的 比较溶栓再通后早期ST段恢复与未恢复者住院期间临床结局的差异，探讨ST段早期恢复在心肌再灌注中的作用。方法 108例溶栓经酶学等指标临床判定再通的急性心肌梗死（AMI）患者，按照有无早期（溶栓后2h)ST段恢复分为两组。连续测定血清肌酸激酶（CK）水平，了解心肌酶峰出现时间及峰值；放射性核素评估左心室功能。观察4周住院期间充血性心力衰竭（CHF）、室壁瘤、心肌梗死后心绞痛发生情况及病死率。结果 无论是前壁MI还是下壁MI，ST段早期恢复组左心室射血分数均高于未恢复组（P＜0．05）；CK峰值则低于未恢复组（P＜0．05）。住院期间ST段恢复组核素心肌显像充盈缺损、CHF及室壁瘤发生率低，心肌梗死后心绞痛发生率高（P值均小于0.05)。结论 同ST段未恢复组相比，溶栓再通后ST段早期恢复者临床预后好。心电图模式可以反映再灌注程度。

Early ST segnent resolution reflects myocardial reperfusion after coronary revascularization with throm-bolytic therapy in patients with acute myocardial infarction

Objectives To compare the differences of clinical outcome in AMI patients with or without early ST segment resolution after successful coronary revascularization with thrombolytic therapy during hospitalization and to assess the influences of rapid ST segment resolution on myocardial reperfusion.Methods One hundred and eight consecutive AMI patients with coronary revascularization after thrombolytic therapy determined by clinical markers were divided into two groups according to with or without rapid (2 hours after thrombolysis)ST resolution.Serum levels of creatine kinase(CK)were measured serially and left ventricular function was assessed by radionuclideimaging.Clinical course was followed up for about 4 weeks during hospitalization. Results Patients with rapid ST segment resolution had higher left ventricular ejection fraction( P <0.05)and lower peak CK( P <0.05),no matter anterior or inferior myocardial infarction;During hospitalization,ST rapid resolution group had lower incidence of myocardial perfusion defect detected by nuclide tomography,CHF and ventricular aneurysm but higher rate of post infarction angina( P <0.05,respectively).Conclusion Compared with those without rapid ST resolution,patients with early resolution of ST segment elevation after successful thrombolytic therapy have better clinical outcome during hospitalization.The ECG pattern might reflect the extent of myocardial reperfusion.