摘要
目的 探讨在不同再灌注时间窗行直接经皮冠状动脉介入（percutaneous coronary intervention,PCI）治疗对急性ST段抬高型心肌梗死（ST-elevation myocardial infarction,STEMI）患者Tp-e、Tp-e/QT比值及恶性室性心律失常（ventricular arrhythmias,VA）的影响。方法 选取发病12 h内行直接PCI治疗的STEMI患者210例,测量PCI治疗前和治疗后100 min心电图中Tp-e及Tp-e/QT比值,按PCI治疗开始时间不同分成3组：3 h组（起病3 h内）、6 h组（起病3~6 h内）、12 h组（起病6~12 h内）。观察3组患者住院期间发生恶性VA的情况。采用受试者工作特征曲线（ROC）评价Tp-e及Tp-e/QT比值对STEMI患者住院期间发生恶性VA的判断价值。结果 （1）住院期间发生恶性VA的STEMI患者Tp-e、Tp-e/QT比值大于未发生恶性VA患者,差异有统计学意义[（118.63±16.89）ms vs.（100.68±14.26）ms,P〈0.01;0.32±0.03 vs.0.27±0.03,P〈0.01]。（2）Tp-e的受试者工作特征曲线下面积（AUC）为0.801（95%CI：0.731~0.871）,Tp-e/QT比值受试者工作特征曲线下面积为0.875（95%CI：0.822~0.927）。（3）STEMI患者直接PCI治疗后Tp-e及Tp-e/QT比值较PCI治疗前明显下降,差异有统计学意义[（106.56±17.20）ms vs.（90.55±12.04）ms,P〈0.01;0.29±0.04 vs.0.25±0.03,P〈0.01];3组间Tp-e及Tp-e/QT比值下降的幅度比较,差异有统计学意义（P〈0.05）;3 h组Tp-e、Tp-e/QT比值下降幅度高于6 h、12 h组,差异有统计学意义（P〈0.05或P〈0.01）;6 h组Tp-e/QT比值下降幅度高于12 h组,差异有统计学意义（P〈0.01）。（4）12 h组PCI治疗后至出院前恶性VA发生率高于3 h组,差异有统计学意义（P〈0.05）。结论 急性STEMI患者在越早再灌注时间窗内行直接PCI治疗,可以更好地恢复心肌细胞电生理稳定性,更多地减少心室复极离散度指标Tp-e、Tp-e/QT比值,降低心肌梗死后VA发生的风险。
Objectives To investigate the impact of different reperfusion time window on Tp-e,Tp-e / QT and malignant ventricular arrhythmias（VA） in patients with acute ST-elevation myocardial infarction（STEMI） receiving primary percutaneous coronary intervention（PCI）. Methods Totally 210 inpatients who underwent primary PCI within 12 hours after onset of acute STEMI were enrolled. Tp-e and Tp-e / QT ratio in electrocardiogram（ECG） were calculated in each patient before and 100 min after PCI. All the inpatients were divided into three groups by reperfusion time ： 3 h group（treated with primary PCI in 3 hours）, 6 h group（treated with primary PCI in 3-6 hours） and 12 h group（treated with primary PCI in 12 hours）. The incidences of malignant VA in the three groups during hospitalization were observed. Receiver operating characteristic curve（ROC） was used to predict the effects of Tp-e and Tp-e / QT ratio on the onset of malignant VA in STEMI patients. Results（1）Tp-e, Tp-e / QT ratios in STEMI patients with malignant VA during hospitalization were significantly higher than those without malignant VA [（118.63±16.89） ms vs.（100.68±14.26） ms, P〈0.01; 0.32 ±0.03 vs. 0.27 ±0.03,P〈0.01 ].（2）ROC data showed that Tp-e（AUC =0.801, 95% CI ：0.731-0.871） and Tp-e / QT ratio（AUC =0.875, 95% CI ： 0.822-0.927）had predictive value for the onset of malignant VA in STEMI patients. ⑶ We found significantly reductions in Tp-e and Tp-e / QT ratio between pre-PCI and post-PCI respectively [（106.56 ±17.20） ms vs.（90.55 ±12.04） ms, P〈0.01; 0.29 ±0.04 vs. 0.25 ±0.03,P〈0.01 ]. There were significant differences in reduction extents of Tp-e and Tp-e / QT ratio among the three groups（P〈0.05）. We found that reduction extents of Tp-e and Tp-e / QT ratio in 3 h group were significantly larger than those in6 h and 12 h groups（P〈0.05 or P〈0.01）, reduction extent of Tp-e / QT ratio in 6 h group was greater than that in 12 h group（P0.01）.（4）Incidence of m
出处
《岭南心血管病杂志》
2015年第3期321-325,共5页
South China Journal of Cardiovascular Diseases
