PCI后TIMI血流及心电图ST段在评价STEMI患者梗死区再灌注中的价值

摘要

目的 分析急性ST段抬高性心肌梗死(STEMI)患者PCI(经皮冠状动脉介入治疗)术后1周及6个月时梗死区的室壁运动情况,评价TIMI血流及ST段回落与梗死区再灌注的关系.方法 选择209例行急诊PCI和56例未行急诊血运重建的急性STEMI患者(对照组),采用二维超声心动图测定心肌梗死后1周及6个月时梗死区的室壁运动.将PCI患者分为3组,A组为PCI后TIMI血流2～3级且2 h内ST段回落≥50%者;B组为PCI后TIMI血流2～3级且2 h内ST段回落＜50%者;C组为PCI后TIMI血流1级且2 h内ST段回落＜50%者.结果 与对照组相比,A组梗死后1周及6个月梗死区的室壁运动均明显改善(P＜0.01),B组梗死后1周梗死区的室壁运动无明显改善,6个月时梗死区的室壁运动较对照组明显改善(P＜0.01),且与A组无统计学差异(P＞0.05);C组梗死后1周及6个月梗死区的室壁运动均无改善(P＞0.05).结论 急性STEMI患者成功PCI后,ST段迅速回落对于判断梗死区早期再灌注具有重要的临床预测价值,而对梗死区远期再灌注的临床预测价值较小;TIMI血流对于判断梗死区远期再灌注具有重要的临床预测价值,而对梗死区早期再灌注的临床预测价值较小.%Objective To analyse infarcted area' s 7 days and 6 months wall motion after primary percutaneous coronary intervention,and evaluate reperfusion in infarcted area by TIMI flow and ST segment resolution. Methods The wall motion of 209 patients with emergency PCI and 56 patients without emergency revascularization ( control group ) were assessed by 2D echocardiograms after 7-day and 6-month in STEMI. Three main groups of patients with emergency PCI were identified. Group A had both TIMI flow grade 2 to 3 and ST-segment elevation recovery in two hours ( ＞ 50％ versus basal ST-segment elevation). Group B had TIMI flow grade 2 to 3 but persistent ST-segment elevation ( ＜ 50％ recovery versus basal ST-segment elevation in two hours). Group C had both TIMI flow grade 1 and persistent ST-segment elevation. Results Compared with the control group, infarcted area' s wall motion were significantly improved in 7 days and 6 months after myocardial infarction in Group A ( P ＜0.01 ). In Group B,infracted area' s wall motion were not improved in 7 days ( P ＞ 0.05 ), but significantly improved in 6 months ( P ＜ 0.01 ). There was no significant difference between Group A and Group B in 6 months( P ＞0.05 ). Infracted area's wall motion in Group C were not improved in 7 days and 6 months after myocardial infarction( P ＞ 0.5). Conclusions TIMI flow grade shows an important predictive value for long-term microvascular reperfusion of the infracted area, but a minor predictor for short-term reperfusion of the infracted area.