心肌缺血分级对急性ST段抬高型心肌梗死患者并发严重心律失常的预测价值分析

目的 探讨心肌缺血分级对急性ST段抬高型心肌梗死（STEMI）患者并发严重心律失常的预测价值.方法 选择急性STEMI患者225例,根据入院时心电图QRS波群形态进行心肌缺血分级并分组：Ⅱ级缺血组135例,Ⅲ级缺血组90例.两组患者在发病12 h内均行溶栓治疗,观察心电图ST段变化及住院期间严重心律失常的发生情况.结果 Ⅲ级缺血组人院时ST段抬高幅度（ΣST）大于Ⅱ级缺血组（0.84±0.57） mV比（0.44±0.35） mV],溶栓后2hΣST仍大于Ⅱ级缺血组（0.50±0.23） mV比（0.11±0.06） mV],差异均有统计学意义（P＜0.01）.Ⅲ级缺血组溶栓后2hST段回降≥50％的比例低于Ⅱ级缺血组56.7％（51/90）比83.7％（113/135）],差异有统计学意义（P＜0.01）.Ⅲ级缺血组肌酸激酶同工酶MB （CK-MB）峰值高于Ⅱ级缺血组（363±105） U/L比（212±97） U/L],差异有统计学意义（P＜0.01）.Ⅲ级缺血组严重心律失常的发生率为18.9％（17/90）,高于Ⅱ级缺血组的11.1％（15/135）,但差异无统计学意义（P＞0.05）.多元Logistic回归分析显示,发病至溶栓时间、入院时ΣST、Ⅲ级缺血是急性STEMI患者发生严重心律失常的独立预测因素,而Ⅲ级缺血的预测意义最强（OR=0.185,P=0.000）.结论 急性STEMI患者入院时心电图呈Ⅲ级缺血,溶栓后易出现ST段回降不良,是发生严重心律失常的独立预测因素.

Predicting value of ischemia grade on arrhythmia in patients with acute ST-segment elevation myocardial infarction

Objective To evaluate clinical significance of ischemia grade to predict severe arrhythmia in patients with acute ST-segment elevation myocardial infarction（STEMI）.Methods A total of 225 patients with STEMI admitting to emergency department were enrolled.All enrolled patients were divided into two groups based on the QRS complex electrocardiogram on admission：grade 1Ⅱ ischemia group（135 cases） and grade Ⅲ ischemia group （90 cases）.All patients received thrombolytic therapy.The incidence rate of ST segment resolution （STR） and severe arrhythmia in hospital stay was observed.Results The ST segment elevation （Σ.ST） on admission and 2 h after thrombolysis in grade Ⅲ ischemia group was significantly higher than that in grade Ⅱ ischemia group （0.84 ± 0.57） mV vs.（0.44 ± 0.35） mV,（0.50 ± 0.23） mV vs.（0.11 ± 0.06） mV] （P ＜ 0.01）.The backing rate of ST segment ≥ 50％ 2 h after thrombolysis in grade Ⅲ ischemia group was significantly lower than that in grade Ⅱ ischemia group 56.7％ （51/90） vs.83.7％ （113/135）] （P ＜0.01）.The creatine kinase MB （CK-MB） peak value in grade Ⅲ ischemia group was significantly higher than that in grade Ⅱ ischemia group （363 ± 105） U/L vs.（212 ± 97） U/L] （P ＜ 0.01）.There was no significant difference in the incidence of severe arrhythmia between two groups （P ＞ 0.05）.Multiple Logistic regression analysis demonstrated that the independent predictors of severe arrhythmia were duration from symptom to thrombolysis and initial ΣST,whereas grade Ⅲ ischemia remained a strong predictor of severe arrhythmia.Conclusion Grade m ischemia on admission is associated with lower incidence of STR in patients with STEMI after thrombolysis and a strong predictor of severe arrhythmia.