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目的探讨急性心肌梗死再灌注治疗后 ST段下降程度与慢性期左心功能的关系。方法将再灌注治疗后 3 0分钟的 ST段高度持续下降超过或等于再灌注治疗前最大 ST段高度 5 0 %的病例作为 ST段下降组 (3 1例 ) ,未达到 5 0 %的病例作为 ST段抬高组 (3 0例 )。根据左室造影对两组间急性期和慢性期梗死局部室壁运动、左室舒张末期容积及左室射血分数 (L VEF)进行比较。结果两组再灌注治疗前 ST段高度、侧支循环形成及梗死前有无心绞痛未见明显差异。发病到开始再灌注治疗的时间 ST段下降组明显短于 ST段抬高组 ,梗死局部室壁运动指数 (SD/chord)在急性期和慢性期有明显改善 (P<0 .0 1)。左室舒张末期容积急性期与慢性期比较无扩大。左室射血分数急性期与慢性期比较明显增加 (P<0 .0 1)。 ST段抬高组 ,SD/chord在急性期和慢性期未见明显改善。左室舒张末期容积急性期与慢性期比较 ,呈现显著扩大 (P<0 .0 1)。左室射血分数急性期与慢性期比较 ,无明显改善。 CK最高值 ,ST段抬高组明显高于ST段下降组 (P<0 .0 1)。再灌注治疗过程中 ST段再度抬高的出现率 ,ST段抬高组明显高于 ST段下降组 (P<0 .0 5 )。结论急性心肌梗死再灌注治疗后 ST段下降程度可以作为判断晚期左室功能改善的指标。
Objective To investigate the relationship between the degree of ST-segment decline and left ventricular function in patients with acute myocardial infarction after reperfusion. Methods Thirty (30) ST-segment heights that continued to decline 30 minutes after reperfusion were continuously decreased by more than or equal to 50% of the maximum ST-segment height before reperfusion as the ST-segment decline group (31 cases) and 50% ST segment elevation group (30 cases). The left ventricular end-diastolic volume and left ventricular ejection fraction (L VEF) were compared between the two groups according to left ventricular angiography. Results There was no significant difference in ST segment height, collateral circulation and angina before infarction before reperfusion in both groups. The onset of reperfusion therapy was significantly shorter in the ST-segment depression group than in the ST-segment elevation disease group. The SD / chord score was significantly improved in the acute and chronic phases (P <0.01). Left ventricular end-diastolic volume in the acute and chronic phase without expansion. Left ventricular ejection fraction increased significantly in acute phase and chronic phase (P <0.01). ST segment elevation group, SD / chord no significant improvement in acute and chronic phase. Left ventricular end-diastolic volume in acute and chronic phase showed a significant increase (P <0.01). Left ventricular ejection fraction in acute and chronic phase, no significant improvement. The highest CK value in ST segment elevation group was significantly higher than that in ST segment depression group (P <0.01). The incidence of re-elevation of ST segment during reperfusion was significantly higher in ST-segment elevation group than in ST-segment depression group (P <0.05). Conclusion The decrease of ST segment after reperfusion in acute myocardial infarction can be used as an index to judge the improvement of left ventricular function in advanced stage.