血栓弹力图在初发急性心肌梗死患者中的临床应用

目的 探讨血栓弹力图(thromboelastography, TEG)监测与急性心肌梗死患者的冠状动脉病变严重程度是否相关、与住院期间主要心血管不良事件(major adverse cardiac events, MACE)是否相关。方法 选择我院初发急性心肌梗死(acute myocardial infarction,AMI )患者(AMI组)80例,健康体检者(正常对照组)30例。根据心电图表现,将AMI组分为急性ST段抬高型心肌梗死(ST elevated myocardial infarction, STEMI )组49例和非ST段抬高型心肌梗死(non ST elevated myocardial infarction, NSTEMI )组31例,在服用抗血小板药物和做急诊冠状动脉介入治疗术前的2小时内抽血监测血栓弹力图,比较两亚组血栓弹力图与冠状动脉病变程度Gensini评分、MACE的关系。结果 AMI组R值和K值均低于正常对照组,且STEMI组R值和K值低于NSTEMI(P<0.05)。AMI组Angle和MA均高于正常对照组,且STEMI 组Angle、MA值、Gensini评分和MACE发生率高于NSTEMI组(P<0.05)。结论 AMI患者的高凝状态预示着更严重的冠状动脉病变、更高MACE发生率。

Clinical application of thromboelastogram in patients with primary acute myocardial infarction

Objective To analyze whether thromboelastogram(TEG)monitoring related to the severity of coronary artery pathological changes in patients with acute myocardial infarction(AMI)and whether it involved with cardiovascular adverse events in hospital.Methods Eighty patients with primary AMI were selected in our hospital as AMI group,30 healthy persons served as normal control group.According to electrocardiogram,AMI group was further divided into 49 cases of acute ST-elevated myocardial infarction(STEMI)group and 31 cases of non-ST-elevated myocardial infarction(NSTEMI)group.Thromboelastogram was monitored by blood drawing within 2 hours before taking antiplatelet drugs and undergoing emergency coronary intervention.The relationship between the thromboelastogram and coronary artery pathological changes degree Gensini score and major adverse cardiac events(MACE)were evaluated in two subgroups.Results The R value and K value of AMI patients were lower than those of normal control group.The R value and K value of STEMI group were lower than those of NSTEMI(P<0.05).The Angle and MA value of patients with AMI were higher than those of normal control group,and the angle,MA value,Gensini score and MACE incidence in STEMI group were higher than those in NSTEMI group(P<0.05).Conclusion Hypercoagulability in patients with AMI predicts more severe coronary artery pathological changes and a higher incidence of MACE.