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目的探讨急性心肌梗死静脉溶栓再通患者1h ST段回落幅度(STR)与血浆型脑利钠肽(BNP)水平变化的关系及对预后评估的意义。方法 31例溶栓再通的急性心肌梗死患者按静脉溶栓1h ST段回落幅度分成A组(n=13,STR≥50%)和B组(n=18,STR<50%)。测定溶栓前,发病24h和5d时的血浆BNP,进行组内及组间比较。结果组内溶栓后BNP水平高于溶栓前(P<0.05),发病5d低于发病24h的BNP(P<0.05),溶栓前和发病24hBNP组间比较差异无统计学意义(P>0.05),A组发病5d BNP明显低于B组(P<0.01)。结论急性心肌梗死患者静脉溶栓再通患者早期ST段回落幅度(STR)可反映心肌再灌注治疗后的微循环情况,是预测临床预后和检出高危患者简便而可靠的方法。
Objective To investigate the relationship between ST-segment drop (ST) at 1h and the plasma level of brain natriuretic peptide (BNP) in patients with recanalization of acute myocardial infarction and its significance in prognosis evaluation. Methods Thirty-one patients with acute myocardial infarction treated by thrombolysis and recanalization were divided into group A (n = 13, STR≥50%) and group B (n = 18, STR <50%) according to the fall rate of ST segment at 1h after intravenous thrombolysis. Before the thrombolytic therapy, the plasma BNP levels at onset of 24h and 5d were compared for intra-and inter-group comparison. Results The level of BNP after thrombolytic therapy was higher than that before thrombolysis (P <0.05), and the incidence of BNP was lower than that of onset of BNP at 5 days (P <0.05). There was no significant difference between before and after thrombolytic therapy (P> 0.05) The incidence of BNP in group A was significantly lower than that in group B on the 5th day (P <0.01). Conclusions The early ST-segment drop (STR) of acute thrombolytic recanalization in patients with acute myocardial infarction can reflect the microcirculation after myocardial reperfusion. It is a simple and reliable method to predict clinical prognosis and detect high-risk patients.