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目的:观察急性心肌梗死在直接经皮冠状动脉成形术(PTCA)前后的体表心电图PTFV_1的变化,分析直接PTCA术对改善急性心梗相关血管缺血情况以及左室功能的作用。方法:对45例共45支梗死相关血管在发病24小时内行直接PTCA干预,其中,LAD20例(44.4%),LCX 7例(15.6%).RCA18例(40%)。所有血管开通后TIMI血流均达2级以上,术前后均测量患者体表PTFV_1值。结果:所有开通相关血管的总PTFV_1值,术前为-0.048±0.012 mm/s,术后立刻、24小时均无显著改变,而在1周及2周分别为-0.039±0.017 mm/s(P<0.05)、-0.034±0.018 mm/s(P<0.001)。而前降支由-0.050±0.018 mm/s 增至第1周的-0.038±0.016 mm/s(P<0.05)及第2周的-0.031±0.014 mm/s(P<0.001)。LCX及RCA从第2周已有显著改变,分别由-0.046±0.012 mm/s增至-0.033±0.011mm/s(P<0.05)及-0.048±0.016mm/s增至-0.033±0.015mm/s(P<0.05),但所有血管均在-0.03 mm/s以下。结论:PTCA对体表心电图PTFV_1在术后第1周已有改变,第2周更明显,说明PTCA能明显改善心肌缺血及左室功能。
Objective: To observe the changes of surface electrocardiogram (PTFV_1) in patients with acute myocardial infarction before and after direct percutaneous transluminal coronary angioplasty (PTCA), and to evaluate the effect of direct PTCA on improving ischemic conditions and left ventricular function in patients with acute myocardial infarction. Methods: Forty-five 45 patients with infarction-related vessels were treated with direct PTCA within 24 hours of onset, of which 20 (44.4%) were LAD, 7 (15.6%) were LCX, and 18 (40%) were RCA. TIMI blood flow reached grade 2 or above after all the vessels were opened, and PTFV_1 values of the body surface were measured before and after operation. Results: The total PTFV_1 values of all related vessels were -0.048 ± 0.012 mm / s preoperatively and no significant changes were observed immediately after operation and at -0.039 ± 0.017 mm / s at 1 week and 2 weeks respectively P <0.05), -0.034 ± 0.018 mm / s (P <0.001). While the anterior descending branch increased from -0.050 ± 0.018 mm / s to -0.038 ± 0.016 mm / s in week 1 (P <0.05) and -0.031 ± 0.014 mm / s in week 2 (P <0.001). LCX and RCA have changed significantly from week 2, increasing from -0.046 ± 0.012 mm / s to -0.033 ± 0.011 mm / s (P <0.05) and -0.048 ± 0.016 mm / s to -0.033 ± 0.015 mm / s (P <0.05), but all blood vessels were below -0.03 mm / s. Conclusion: PTCA has changed the body surface electrocardiogram PTFV_1 in the first week after operation, and the second week is more obvious. It shows that PTCA can significantly improve myocardial ischemia and left ventricular function.