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目的探讨急诊经皮冠状动脉介入治疗(PCI)前,床边快速检测血清肌钙蛋白I(cTnI)、肌红蛋白(MYO)、肌酸激酶同功酶(CK-MB)对急性心肌梗死(AMI)是否需要行PCI的价值。方法选择2009年1月-2011年12月临床诊断为AMI患者105例,在决定急诊PCI前,床边快速检测cTnI、MYO、CK-MB(心肌梗死三项),进一步明确心肌梗死的诊断,决定是否立即PCI。并计算三项指标诊断AMI的敏感性、特异性、阳性预测值及阴性预测值。结果 105例中,最终确诊为AMI 81例,行急诊PCI 79例,术中证实为冠状动脉病变导致AMI 78例,主动脉夹层导致右冠状动脉闭塞1例。MYO诊断AMI的敏感性为88.9%,特异性为58.3%,阳性预测值为87.8%;CK-MB诊断AMI的敏感性为65.4%,特异性为79.2%,阳性预测值为91.4%;cTnI诊断AMI的敏感性为54.3%,特异性为91.7%,阳性预测值为95.7%。结论急诊PCI术前床边快速心梗三项检查,操作简便,敏感性、特异性、阳性预测值均高,能为临床提供快速、准确、可靠的诊断依据,适用于急诊PCI前检查明确诊断。
Objective To investigate the effects of cTnI, MYO and CK-MB on acute myocardial infarction (AMI) before acute percutaneous coronary intervention (PCI) AMI) need to do PCI value. Methods A total of 105 patients with AMI diagnosed from January 2009 to December 2011 were enrolled in this study. CtnI, MYO and CK-MB (myocardial infarction) were detected at the bedside before the emergency PCI was determined. The diagnosis of myocardial infarction was further clarified, Decide whether to immediately PCI. The sensitivity, specificity, positive predictive value and negative predictive value of three indexes in diagnosing AMI were calculated. Results Among the 105 cases, 81 cases were diagnosed as AMI in final diagnosis and 79 cases were diagnosed as emergency PCI. Among them, 78 cases were diagnosed as coronary artery lesion and 1 case was occluded by aortic dissection. The sensitivity and specificity of MYO in diagnosing AMI were 88.9%, 58.3% and 87.8%, respectively. The sensitivity and specificity of CK-MB in diagnosing AMI were 65.4%, 79.2% and 91.4% respectively. The diagnostic value of cTnI The sensitivity of AMI was 54.3%, the specificity was 91.7% and the positive predictive value was 95.7%. Conclusions Emergency bedside myocardial infarction with three tests before operation is simple, sensitive, specific and positive predictive value. It can provide a fast, accurate and reliable basis for clinical diagnosis. It is suitable for the diagnosis of acute pre-PCI .