摘要
目的探讨院前心电图(PH-ECG)对急性ST段抬高型心肌梗死(STEMI)患者再灌注治疗和预后的影响。方法回顾性分析239例急性STEMI患者PH-ECG检查情况,根据是否行PH-ECG检查分为PH-ECG组116例和无PH-ECG组(NPH-ECG组)123例。所有患者接受再灌注治疗(急诊经皮冠状动脉介入治疗),比较两组再灌注时间、TIMI血流分级及30 d病死率等指标;分析急性STEMI合并心力衰竭(Killip 2～4级)患者PH-ECG与30 d病死率的关系。结果 PH-ECG组患者再灌注时间短于NPH-ECG组,差异有统计学意义(P<0.05);PH-ECG组术后TIMI血流分级0～2级、30 d病死率及主要不良心脏事件(MACE)发生率均低于NPH-ECG组,差异有统计学意义(P<0.05);PH-ECG组替罗非班使用率高于NPH-ECG组,差异有统计学意义(P<0.05)。(2)根据Killip分级分析30 d病死率的危险因素,进行多元Logistic回归分析,结果显示,Killip 1～4级患者的危险因素聚集、多支病变、术前TIMI血流分级0级和术后TIMI血流分级0～2级;Killip 2～4级患者的危险因素聚集、多支病变、术前TIMI血流分级0级和术后TIMI血流分级0～2级;Killip 2～3级患者PH-ECG和术后TIMI血流分级0～2级均进入回归方程。结论 PH-ECG有助于缩短心肌再灌注时间,尤其能改善急性STEMI合并轻至中度心力衰竭患者预后,建议临床广泛推广。
Objective To explore the effect of pre - hospital electrocardiogram （ PH - ECG） on the efficacy of reper- fusion and prognosis in patients with ST elevation myocardial infarction （STEMI）. Methods The PH - ECG examinations of 239 acute STEMI patients were retrospectively analyzed, and all the patients were divided into PH- ECG group （116 cases） and N PH -ECG group （123 cases）. All the patients were given reperfusion （emergency percutaneous coronary intervention）. The reperfusion time, TIMI flow grades and 30d mortality rate of the two groups were compared. The relationship between PH -ECG and 30d mortality rate in acute STEMI patients combined with heart failure （Killip 2 - 4 degree） was analyzed. Re- suits （1） 116 patients were given PH -ECG examination. The reperfusion time of PH -ECG group was significantly shorter than the N PH - ECG group （P 〈 0. 05）. The 0 - 2 degree of TIMI flow grades, 30 d mortality rate and MACE rate after surgery in PH - ECG group were all significantly lower than the N PH - ECG group （ P 〈 0. 05 ）. The usage rate of tirofiban in PH - ECG group was significantly higher than in the N PH - ECG group （P 〈 0. 05 ）. （2） The risk factors of 30d mortality rate were ana- lyzed based on the Killip grading, and muhiple regression analysis showed that patients with Killip degree of 1 - 4 had clustering of risk factors, multiple lesions, preoperative TIMI flow grades of 0 and postoperative TIMI flow grades of 1 - 2 ; Patients with Killip degree of 2 - 4 had clustering of risk factors, multiple lesions, preoperative TIMI flow grades of 0 and postoperative TIMI flow grades of 0 -2 ; Patients with Killip degree of 2 - 3 had PH - ECG and postoperative TIMI flow grades of 0 - 2 enter the re- gression equation. Conclusion PH - ECG can reduce the reperfusion time and improve the clinical outcome of STEMI patients, particularly in STEMI patients with mild to moderate symptoms of heart failure. It is recommended in clinic.
出处
《中国全科医学》
CAS
CSCD
北大核心
2013年第26期3116-3118,共3页
Chinese General Practice
关键词
心电描记术
心肌梗死
心肌再灌注
Electrocardiography
Myocardial infarction
Myocardial reperfusion
