冠脉内乳酸水平对急性心肌梗死患者症状改善和心功能的影响

摘要

Objective To evaluate lactate level in coronary artery as a predictor of symptoms improvement and cardiac function after emergency coronary intervention in patients with acute myocardial infarction. Methods Nine-ty-six patients with acute anterior wall myocardial infarction who underwent emergency coronary intervention were chosen in our hospital from January 2013 to June 2014, with all the left anterior descending coronary artery of acute oc-clusive lesions. 10 ml coronary blood was obtained by thrombus suction catheter for lactate level detection. According to coronary lactate level, 31 patients were divided into high lactate level group (≥2 mmol/L), and 65 patients were divided into low lactate level group (<2 mmol/L). Rate of chest pain relief, ECG ST segment decline and reperfusion arrhythmia 2 hours after operation, presence of heart failure, left ventricular end-diastolic diameter, ejection fractions (EF) index and brain natriuretic peptides (BNP) one week after operation were observed. Results Rate of chest pain relief and ECG ST segment decline, reperfusion arrhythmia showed statistically significant difference between high lactate level group [(75.8±8.23)%, (75.1±7.34)%, 61.3%] and low lactate level group [(82.1±8.41)%, (81.6±8.12)%, 32.3%],P<0.05. Pres-ence of heart failure, left ventricular end-diastolic diameter, EF index and BNP also showed statistically significant difference between high lactate level group [71.0%, (46.1±2.13) mm, (47.4±2.36)%, (238.6±12.34) pg/ml] and low lactate level group [27.7%, (44.6 ± 1.86) mm, (49.8 ± 2.65)%, (193.7 ± 9.86) pg/ml], P<0.05. Conclusion The lactate level in coronary artery is closely related with chest pain relief, ST segment decine and reperfusion arrhythmia within 2 hours after operation. At the same time, the lactate level also exerts significant effect on cardiac function one week after operation.%目的 研究冠脉内乳酸水平对急性心肌梗死患者急诊冠脉介入术后症状改善和心功能的影响.方法 选取2013年1月至2014年6月在我院行急诊冠脉介入治疗的急性前壁心肌梗死患者96例,术中左前降支均为急性闭塞病变,使用血栓抽吸导管取得冠脉内血液10 ml,行乳酸水平测定,根据冠脉内乳酸水平是否大于2 mmol/L,把患者分为高乳酸组31例和低乳酸组65例.观察两组患者术后2 h内胸痛缓解、心电图ST段回落和再灌注心律失常比例以及术后一周心功能不全、左室舒张末内径、射血分数和BNP情况.结果 高乳酸组术后2 h内的胸痛缓解比例、心电图ST段回落比例和再灌注心律失常比例分别为(75.8±8.23)%、(75.1±7.34)%和61.3%,低乳酸组分别为(82.1±8.41)%、(81.6±8.12)%和32.3%,两组间比较差异均有统计学意义(P<0.05).高乳酸组术后一周心功能不全比例、左室舒张末内径、射血分数和BNP分别为71.0%、(46.1±2.13) mm、(47.4±2.36)%和(238.6±12.34) pg/ml,低乳酸组分别为27.7%、(44.6±1.86) mm、(49.8±2.65)%和(193.7±9.86) pg/ml,两组间比较差异均有统计学意义(P<0.05).结论 急性前壁心肌梗死患者冠脉内乳酸水平与术后2 h内患者胸痛缓解情况、ST段回落及再灌注心律失常发生密切相关,同时也对患者术后一周心功能有显著影响.