急性心肌梗死溶栓后ST段的下降幅度对预后的影响

目的　探讨急性心肌梗死 (AMI)溶栓后心电图ST段的下降幅度对预后的影响及进一步治疗的价值。方法　将 78例AMI患者按溶栓后 6 0min、12 0min、180min、1d、3d等各时段记录的心电图ST段恢复情况 ,分为ST段基本回到基线 (恢复≥ 90 % ) (A组 )、ST段恢复≥ 5 0 %而 <90 % (B组 )和ST段恢复 <5 0 % (C组 )。比较 3组的住院心脏性病死率和左室功能 ,对ST段反复波动者、左室功能差者进一步治疗。结果　C组较A组、B组CPK峰值、心脏性病死率和左室射血分数存在显著性差异 (P <0 .0 1) ,尤以A组预后最佳、左室功能良好 ,C组建议进一步行PTCA术及冠脉内支架植入术为多。结论　心电图监测AMI溶栓后ST段的变化 ,有助于对预后评估并及时为高危患者进一步治疗提供依据。

Effect of ST segment depression on prognosis in patients with acute myocardial infarction after thrombolytic therapy

Objective To investigate the effect of ST segmnt depression on prognosis in patients with acute myocardial infarction (AMI) after thrombolytic therapy.Methods 78 patients with AMI were divided into three groups. Group A: ST segment was almost on base line; group B: ST segment descended between 50% to 90%; group C: less than 50%.The hospitalization cardiogenic mortality and the function of left ventricle were compared, the patients whose ST segment was repeatedly fluctuated, with poor function of left ventricle, were further treated in hospital.Results There were significant differences in CPK hump, the cardiogenic mortality and ejection fraction of left ventricle between group C and group A as well as group B.Especially,group A was the best in prognosis and the function of left ventricle among the three groups. It was suggested that group C should be treated out by PTCA surgery and intracoronary sent implantation.Conclusion The ECG's surveillance for the ST segment after thrombolytic therapy is a kind of method that is very important for prognosis and further therapy in high risk patients.