论文部分内容阅读
目的探讨不同ST段抬高形态的心肌梗死对心肌缺血再灌注损伤的影响。方法选取行急诊介入(PCI)治疗的急性初发前壁心肌梗死患者42例,根据心电图ST段抬高形态,分为凸面向上组(A组)24例,凹面向上组(B组)18例,观察再灌注心律失常、冠状动脉无复流现象及对心肌梗死范围及心功能的影响。结果B组梗死前心绞痛发生率高于A组,再灌注室性心律失常显著低于A组(44%vs71%,P<0.05),冠状动脉无复流现象低于A组(11%vs25%,P<0.05),心肌酶峰值均较A组显著降低,病理性Q波导联数和ST段抬高导联数较A组显著减少分别为[(2.5±1.0)vs(3.7±1.7)和(4.0±0.9)vs(5.2±1.3),P<0.05],而左心室射血分数高于A组[(59±11)%vs(45±9)%,P<0.05],前降支侧支循环建立优于A组。结论ST段凹面向上抬高的心肌梗死患者与经典的凸面向上抬高的患者相比,心肌缺血再灌注损伤明显减轻。其机制与缺血预适应及侧支循环有关。
Objective To investigate the effects of myocardial infarction with different ST segment elevation on myocardial ischemia-reperfusion injury. Methods Forty-two patients with acute primary anterior myocardial infarction (MI) treated by PCI were divided into two groups according to the ST segment elevation pattern of electrocardiogram (ECG): 24 cases in convex upward group (group A), 18 cases in concave upward group (group B) The effects of reperfusion arrhythmia, no-reflow of coronary artery, myocardial infarction and cardiac function were observed. Results The incidence of pre-infarction angina in group B was higher than that in group A, and the reperfusion arrhythmia was significantly lower in group B than in group A (44% vs 71%, P <0.05) , P <0.05). The peak of myocardial enzymes was significantly lower than that of group A (P <0.05), and the number of pathological Q waveguides and ST segment elevation leads were significantly decreased compared with those in group A [(2.5 ± 1.0) vs (4.0 ± 0.9) vs (5.2 ± 1.3), P <0.05], while the left ventricular ejection fraction was significantly higher than that in group A [(59 ± 11)% vs (45 ± 9)%, P <0.05] Collateral circulation is better than A group. Conclusions Myocardial ischemia-reperfusion injury was significantly reduced in patients with myocardial infarction with an upward concave ST-segment as compared with patients with elevated classic convexity. Its mechanism and ischemic preconditioning and collateral circulation.