STEMI梗死相关动脉自发再灌注患者经PCI治疗前后Tp-e间期变化的预后价值

发布时间：2018-05-31 03:18

本文选题：ST段抬高性心肌梗死 + 自发再灌注　；参考：《郑州大学》2017年硕士论文

【摘要】：目的探讨经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的ST段抬高性心肌梗死(ST-segment elevation myocardial infarction,STEMI)相关动脉自发再灌注患者的Tp-e间期、Tp-e间期/QT间期(Tp-e/QT)与恶性心律失常事件发生的相关性及其预后价值。探讨心电图上Tp-e间期的形成机制,是代表心室跨膜复极离散度还是代表整体心脏的复极离散度。方法选取2014年10月至2016年10月在郑州大学人民医院心内科住院的288例STEMI患者资料。PCI术前造影显示梗死相关冠脉TIMI血流0、1级患者入选闭塞组,TIMI血流2、3级患者入选自发再灌注组,要求两组间年龄和性别差异无统计学意义。急性心肌梗死患者在入院后行常规12导联(必要时18导联)心电图,并行床旁监护,对胸痛12h以内或12至24 h以内仍有胸痛症状者,行冠状动脉造影,必要时行球囊扩张加支架植入术入组。PCI术前1小时(1hour,1h)、PCI术后1小时(1hour,1h)、1周(1week,1w)连续对患者行常规12导联心电图检查,记录患者Tp-ec,Tp-e/QT指标数值。对STEMI患者PCI术后行床旁心电监护2周,记录恶性心律失常事件(malignant arrhythmia events,MAE)发生例数。结果(1)自发再灌注组与闭塞组相比,两组在并发高血压病(6.3%:46.7%;P0.001)、糖尿病(3.2%:33.3%;P0.001)、脑血管病(4.8%:14.7%;P=0.012)、吸烟史(7.9%:64.0%;P0.001)、饮酒史(9.5%:52.0%;P0.001)、血清胆固醇(3.7±0.8mmol/L:5.7±0.6mmol/L;P=0.021)、白细胞(5.1±1.3 10^9/L:11.4±2.610^9/L;P0.001)方面差异有统计学意义(P0.05);(2)自发再灌注组PCI后1 h(91.4±5.6ms;0.240±0.034)与PCI前1 h(111.4±7.7ms;0.281±0.028)、PCI后1w(85.6±6.3ms;0.225±0.028)与PCI后1 h(91.4±5.6ms;0.240±0.034)相比,其Tp-ec、Tp-e/QT均有明显缩短(P0.05)。闭塞组PCI后1 h(100.1±5.5ms;0.264±0.026)与PCI前1 h(119.5±9.0ms;0.312±0.027)、PCI后1w(92.0±4.6ms;0.243±0.023)与PCI后1 h(100.1±5.5ms;0.264±0.026)相比,其Tp-ec、Tp-e/QT均有明显缩短(P0.05)。自发再灌注组与闭塞组在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)同一时间点相比,两组间的Tp-ec、Tp-e/QT差异均有统计学意义(P0.05)。(3)STEMI梗死相关动脉自发再灌注患者PCI前1h的Tp-ec以120ms为节点分组,两组间恶性心律失常事件的发生有明显差异(3.1%:32.3%;P=0.002);PCI前1h的Tp-e/QT以0.30为节点分组,两组间恶性心律失常事件的发生有明显差异(5.9%:31.0%;P=0.009)。自发再灌注组在PCI前1 h的Tp-ec、Tp-e/QT越短,其发生恶性心律失常事件发生机率越低。(4)多变量logistic回归分析示并发糖尿病(OR=5.200,95%CI:2.003-13.498;P=0.001)、有吸烟史(OR=11.714,95%CI:3.215-42.677;P0.001)、血清胆固醇(OR=5.029,95%CI:1.867-13.545;P=0.001)是STEMI患者PCI术后发生恶性心律失常事件的相关危险因素。较正了相关风险危险因素之后,STEMI患者PCI术前无自发再灌注是其术后MAE发生的独立危险因素。结论1、多变量logistic回归分析较正了STEMI患者并发糖尿病、吸烟史、血清胆固醇相关风险危险因素之后,STEMI患者PCI术前有自发再灌注是其术后MAE发生的保护因素。2、STEMI梗死相关动脉自发再灌注患者经PCI治疗前的Tp-e间期、Tp-e/QT越短,发生恶性心律失常事件的机率越低,二者有明显的相关性。3、Tp-e间期可以作为间接反映心室跨膜复极离散度的观测指标。
[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.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R542.22

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