本文選題：ST段抬高性心肌梗死 + 自發(fā)再灌注��； 參考：《鄭州大學》2017年碩士論文

【摘要】：目的探討經(jīng)皮冠狀動脈介入治療(percutaneous coronary intervention,PCI)的ST段抬高性心肌梗死(ST-segment elevation myocardial infarction,STEMI)相關動脈自發(fā)再灌注患者的Tp-e間期、Tp-e間期/QT間期(Tp-e/QT)與惡性心律失常事件發(fā)生的相關性及其預后價值。探討心電圖上Tp-e間期的形成機制,是代表心室跨膜復極離散度還是代表整體心臟的復極離散度。方法選取2014年10月至2016年10月在鄭州大學人民醫(yī)院心內(nèi)科住院的288例STEMI患者資料。PCI術前造影顯示梗死相關冠脈TIMI血流0、1級患者入選閉塞組,TIMI血流2、3級患者入選自發(fā)再灌注組,要求兩組間年齡和性別差異無統(tǒng)計學意義。急性心肌梗死患者在入院后行常規(guī)12導聯(lián)(必要時18導聯(lián))心電圖,并行床旁監(jiān)護,對胸痛12h以內(nèi)或12至24 h以內(nèi)仍有胸痛癥狀者,行冠狀動脈造影,必要時行球囊擴張加支架植入術入組。PCI術前1小時(1hour,1h)、PCI術后1小時(1hour,1h)、1周(1week,1w)連續(xù)對患者行常規(guī)12導聯(lián)心電圖檢查,記錄患者Tp-ec,Tp-e/QT指標數(shù)值。對STEMI患者PCI術后行床旁心電監(jiān)護2周,記錄惡性心律失常事件(malignant arrhythmia events,MAE)發(fā)生例數(shù)。結果(1)自發(fā)再灌注組與閉塞組相比,兩組在并發(fā)高血壓病(6.3%:46.7%;P0.001)、糖尿病(3.2%:33.3%;P0.001)、腦血管病(4.8%:14.7%;P=0.012)、吸煙史(7.9%:64.0%;P0.001)、飲酒史(9.5%:52.0%;P0.001)、血清膽固醇(3.7±0.8mmol/L:5.7±0.6mmol/L;P=0.021)、白細胞(5.1±1.3 10^9/L:11.4±2.610^9/L;P0.001)方面差異有統(tǒng)計學意義(P0.05);(2)自發(fā)再灌注組PCI后1 h(91.4±5.6ms;0.240±0.034)與PCI前1 h(111.4±7.7ms;0.281±0.028)、PCI后1w(85.6±6.3ms;0.225±0.028)與PCI后1 h(91.4±5.6ms;0.240±0.034)相比,其Tp-ec、Tp-e/QT均有明顯縮短(P0.05)。閉塞組PCI后1 h(100.1±5.5ms;0.264±0.026)與PCI前1 h(119.5±9.0ms;0.312±0.027)、PCI后1w(92.0±4.6ms;0.243±0.023)與PCI后1 h(100.1±5.5ms;0.264±0.026)相比,其Tp-ec、Tp-e/QT均有明顯縮短(P0.05)。自發(fā)再灌注組與閉塞組在PCI前1 h(111.4±7.7:119.5±9.0ms;0.281±0.028:0.312±0.027)、后1 h(91.4±5.6:100.1±5.5ms;0.240±0.034:0.264±0.026)、后1w(85.6±6.3:92.0±4.6ms;0.225±0.028:0.243±0.023)同一時間點相比,兩組間的Tp-ec、Tp-e/QT差異均有統(tǒng)計學意義(P0.05)。(3)STEMI梗死相關動脈自發(fā)再灌注患者PCI前1h的Tp-ec以120ms為節(jié)點分組,兩組間惡性心律失常事件的發(fā)生有明顯差異(3.1%:32.3%;P=0.002);PCI前1h的Tp-e/QT以0.30為節(jié)點分組,兩組間惡性心律失常事件的發(fā)生有明顯差異(5.9%:31.0%;P=0.009)。自發(fā)再灌注組在PCI前1 h的Tp-ec、Tp-e/QT越短,其發(fā)生惡性心律失常事件發(fā)生機率越低。(4)多變量logistic回歸分析示并發(fā)糖尿病(OR=5.200,95%CI:2.003-13.498;P=0.001)、有吸煙史(OR=11.714,95%CI:3.215-42.677;P0.001)、血清膽固醇(OR=5.029,95%CI:1.867-13.545;P=0.001)是STEMI患者PCI術后發(fā)生惡性心律失常事件的相關危險因素。較正了相關風險危險因素之后,STEMI患者PCI術前無自發(fā)再灌注是其術后MAE發(fā)生的獨立危險因素。結論1、多變量logistic回歸分析較正了STEMI患者并發(fā)糖尿病、吸煙史、血清膽固醇相關風險危險因素之后,STEMI患者PCI術前有自發(fā)再灌注是其術后MAE發(fā)生的保護因素。2、STEMI梗死相關動脈自發(fā)再灌注患者經(jīng)PCI治療前的Tp-e間期、Tp-e/QT越短,發(fā)生惡性心律失常事件的機率越低,二者有明顯的相關性。3、Tp-e間期可以作為間接反映心室跨膜復極離散度的觀測指標。
[Abstract]:Objective to investigate the correlation and prognostic value of ST segment elevation myocardial infarction (ST-segment elevation myocardial infarction, STEMI) associated arterial spontaneous reperfusion in patients with ST segment elevation myocardial infarction (percutaneous coronary intervention, PCI). The formation mechanism of the Tp-e interval on the electrocardiogram is to represent the interventricular transmembrane repolarization dispersion or the repolarization dispersion of the whole heart. Methods 288 patients with STEMI in the Department of Cardiology, the Department of Cardiology, Zhengzhou University, from October 2014 to October 2016, were selected to display the TIMI blood flow of infarct related coronary artery in 0,1. In the occlusion group, the patients with TIMI blood flow 2,3 were enrolled in the spontaneous reperfusion group. The age and sex differences between the two groups were not statistically significant. The patients with acute myocardial infarction underwent routine 12 lead (necessary 18 lead) electrocardiogram, parallel bedside monitoring, and patients with chest pain within 12h or 12 to 24 h. Coronary angiography was necessary. 1 hours before.PCI (1hour, 1H), 1 hours after PCI (1hour, 1H), and 1 weeks (1week, 1W), routine 12 lead electrocardiogram (1week, 1W) were performed in the group, and the patients' Tp-ec and Tp-e/QT index values were recorded. For STEMI patients after PCI surgery, the ECG monitoring for 2 weeks was performed to record the malignant arrhythmia events. Vents, MAE) results (1) the spontaneous reperfusion group was compared with the occlusion group, two groups were complicated with hypertension (6.3%: 46.7%; P0.001), diabetes (3.2%: 33.3%; P0.001), cerebrovascular disease (4.8%: 14.7%; P=0.012), smoking history (7.9%: 64%; P0.001), drinking history (9.5%: 52%; P0.001), serum cholesterol (3.7 + 0.8mmol/L:5.7 + 0.6mmol/L; P=0.021), white thin The difference in cell (5.1 + 1.3 10^9/L:11.4 + 2.610^9/L; P0.001) was statistically significant (P0.05); (2) 1 h (91.4 + 5.6ms; 0.240 + 0.034) after PCI in the spontaneous reperfusion group and 1 h before PCI (111.4 + 7.7ms; 0.281 + 0.281), and PCI 1W (85.6 + 0.240). After PCI, 1 h (100.1 + 5.5ms; 0.264 + 0.026) and PCI 1 h (119.5 + 9.0ms; 0.312 + 0.027), PCI 1W (92 + 4.6ms; 0.243 + 0.023) compared with PCI H (100.1 + 5.5ms; 0.264 +). After 1 h (91.4 + 5.6:100.1 + 5.5ms; 0.240 + 0.034:0.264 + 0.026), and 1W (85.6 + 6.3:92.0 + 4.6ms; 0.225 + 0.028:0.243 + 0.023) at the same time point, the difference between Tp-ec and Tp-e/QT in the two groups was statistically significant (P0.05). (3) two groups were divided and two groups were malignant The occurrence of arrhythmia events was significantly different (3.1%: 32.3%; P=0.002); Tp-e/QT before PCI was divided into 0.30 nodes, and there were significant differences in the occurrence of malignant arrhythmia events between the two groups (5.9%: 31%; P=0.009). The shorter the Tp-ec of the spontaneous reperfusion group in the pre PCI 1 h, the lower the probability of the occurrence of malignant arrhythmia. (4) multivariable Logistic regression analysis showed concurrent diabetes (OR=5.200,95%CI:2.003-13.498; P=0.001), smoking history (OR=11.714,95%CI:3.215-42.677; P0.001), serum cholesterol (OR=5.029,95%CI:1.867-13.545; P=0.001) is a related risk factor for STEMI patients with malignant arrhythmia after PCI operation. After the relative risk risk factors, STEMI, STEMI No spontaneous reperfusion was an independent risk factor for postoperative MAE in patients with PCI. Conclusion 1, multivariate logistic regression analysis was more than STEMI patients complicated with diabetes, smoking history, and risk factors for serum cholesterol related risk. After PCI, spontaneous reperfusion was the protective factor.2 for postoperative MAE and STEMI infarct related factors in STEMI patients. The shorter the Tp-e interval before PCI treatment, the shorter the Tp-e/QT, the lower the incidence of malignant arrhythmia events, the two has a significant correlation of.3, and the Tp-e interval can be used as an indicator to indirectly reflect the ventricular transmembrane repolarization dispersion.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R542.22

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