急诊经皮冠状动脉介入治疗术前心电图参数对术后心肌再灌注水平的预测价值

目的探讨急性ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI）术前心电图参数预测急诊PCI术后的心肌再灌注水平的价值，寻找能够尽早提示急诊PCI术后疗效的检测手段。方法回顾性分析65例行急诊PCI术的急性STEMI患者发病时心电图的各项参数与术后心肌梗死溶栓治疗（TIMI）分级的相关程度，筛选无复流现象的独立危险因素。结果65例急诊PCI患者中，无复流患者17例，发生率为26．2％。比较无复流组与正常血流组患者的术前心电图参数，ST段抬高类型差异有统计学意义（P〈0．05），以ST段呈C型抬高者无复流发生率最高（34．8％，16／46）；而QRS记分、ST段抬高导联数目、ST段抬高总和差异无统计学意义。多因素logistic回归分析表明：C型ST段抬高是无复流现象发生的独立危险因素（OR=8．956，95％CI=1．189，67．456，P=0．033）。结论作为一项简明的心电图参数，C型ST段抬高可以预测急诊PCI术后冠状动脉无复流现象，有利于术前、术中预见性地采取防治该现象的措施。

Value of pre-PCI ECG parameters in predicting myocardial reperfusion level after emergency PCI

Objective To investigate whether the electrocardiography（ECG） parameters can be used to predict the myocardial reperfusion level after emergency percutaneous coronary intervention （PCI）. Methods Clinical and angiographic data of 65 patients who underwent primary PCI for ST-segment elevation myocardial infarction（STEMI） were retrospectively analyzed. The relationship between the pre-PCI ECG parameters and the myocardial reperfusion level was analyzed. The independent risk factors of no-reflow were selected by multiple stepwise logistic regression analysis. Results No re-flow occurred in 17 of fi5 patients （26.2%） who underwent emergency primary PCI. ST-segment elevation pattern was statistically significant between no-reflow group and reflow group, no re-flow rate （34.8%） was more in the patients with type C ST elevation （ P d0.05）. Multiple stepwise logistic regression analysis demonstrated that type C ST-segment elevation was the only independent risk factor for no-fellow phenomenon after primary PCI （ OR=8. 956,95% CI = 1. 189 to 67. 456, P =0. 033）. Conclusion ST-segment elevation pattern （type C） can predict coronary no-reflow phenomenon after primary PCI in patients with STEMI.