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目的:早期识别主要心血管不良事件(MACE)高危患者,积极干预,探索影响ST段回落的因素。方法:收集成功溶栓的ST段抬高型心肌梗死(STEMI)患者58例,分别测算溶栓前、溶栓后2h梗死相关导联校正的QT间期(QTc)、单导联ST段回落(STR)、校正的T波顶点到T波终点的时间(Tp-ec)、Tp-e/QT比值等指标的变化,随访6个月内发生MACE情况。以STR50%为切点,分为STR>50%组与STR<50%组,分析溶栓前后QTc、Tp-ec、Tp-e/QT变化的数值和不同变化幅值例数与STR程度的关系。χ2检验分析STR与Tp-ec、Tp-e/QT变化在不同切点对6个月MACE发生的差异。结果:STR≥50%组MACE发生率明显低于STR<50%组(P<0.05)。ΔTp-e/QT≥0.04组MACE发生率明显低于<0.04组(P<0.05);而ΔTp-ec以25ms为切点两组间差异无统计学意义。溶栓前后QTc变化(ΔQTc)数值在STR≥50%和STR<50%组差异无统计学意义。不同变化幅值例数比较:ΔTp-ec≥25ms组STR≥50%比例明显大于ΔTp-ec<25ms组,ΔTp-e/QT≥0.04组STR≥50%比例明显大于ΔTp-e/QT<0.04组(P<0.05)。Logistic回归分析显示ST段回落不良的预测因素有前壁心肌梗死、入院Killip分级2级以上、入院白细胞计数、胸痛至溶栓时间。结论:溶栓后2hSTR可预测住院期间、6个月MACE的发生;急性STEMI患者Tp-ec、Tp-e/QT的变化与溶栓前后STR相关,有望成为替代STR预测预后的临床简易指标;前壁心肌梗死、入院Killip分级2级以上、入院白细胞计数、胸痛至溶栓时间可影响STR。
OBJECTIVE: To identify early high-risk patients with major cardiovascular adverse events (MACE) and actively intervene to explore the factors influencing ST-segment depression. Methods: Fifty-eight patients with STEMI were enrolled in this study. The corrected QTc (QTc), ST-segment depression (Tp-ec), Tp-e / QT ratio (Tp-e / QT) of the corrected T-wave peak to the end of the T wave. The changes of QTc, Tp-ec and Tp-e / QT before and after thrombolytic therapy were analyzed with STR50% as the cut-off point, and divided into STR> 50% and STR <50% relationship. χ2 test analysis of STR and Tp-ec, Tp-e / QT changes at different points of 6 months MACE differences. Results: The incidence of MACE in STR≥50% group was significantly lower than that in STR <50% group (P <0.05). The incidence of MACE in ΔTp-e / QT≥0.04 group was significantly lower than that in <0.04 group (P <0.05). There was no significant difference between the two groups when ΔTp-ec was cut at 25 ms. Changes in QTc before and after thrombolysis (ΔQTc) in the STR ≥ 50% and STR <50% group differences were not statistically significant. The proportion of cases with different changes in amplitude: ΔTp-ec≥25ms, STR≥50% was significantly higher than ΔTp-ec <25ms, and ΔTp-e / QT≥0.04 was significantly higher than ΔTp-e / QT <0.04 Group (P <0.05). Logistic regression analysis showed that the prognostic factors of ST-segment depression were anterior myocardial infarction, admission to Killip grade 2 or above, admission white blood cell count, chest pain to thrombolysis time. CONCLUSIONS: 2hSTR after thrombolysis can predict the occurrence of MACE during 6 months of hospitalization. The changes of Tp-ec and Tp-e / QT in patients with acute STEMI are correlated with STR before and after thrombolysis, which is expected to be a clinical simple alternative to predict the prognosis of STR. Anterior myocardial infarction, admission Killip graded 2 or more, admission white blood cell count, chest pain to thrombolysis time can affect STR.