【摘要】 目的探讨急诊PCI对急性ST段抬高心肌梗死（STEMI）患者跨室壁复极离散度的影响。方法选择STEMI患者341例,其中未能实现梗死相关冠状动脉再通者129例为非再通组,经急诊PCI再通者212例为再通组;另选择非冠心病者36例为对照组。以校正的T波顶点至终点时间(Tp e/c,Tp-e/RR^1/2)作为跨室壁复极离散度量化指标。比较正常者与STEMI患者、再通组与非再通组的Tp-e/c值:以及影响急诊PCI术后Tp-e/c下降幅度的相关因素。结果非再通组Tp-e/c较对照组明显升高（P<0.01）,且在入院即刻、第2、3天差异无统计学意义（P>0.05）。再通组不同梗死相关冠状动脉在术后即刻、第2、3天Tp-e/c下降幅度差异无统计学意义（P>0.05）。再通组Tp-e/c下降幅度与ST段回落程度、肌酸激酶同工酶、肌钙蛋白I、左心室舒张末内径呈独立正相关（r=0.381,r=0.238,r=0.201,r=0.147,P<0.01）,与LVEF、Killip分级呈独立负相关（r=-0.1 98,P<0.01;r=-0.1 62,P<0.05）。结论急诊PCI能有效降低患者跨室壁复极离散度,该效果与不同梗死相关冠状动脉无关,而与ST回落程度、心肌标记物水平及左心室收缩功能有关。更多还原

【Abstract】 Objective To probe the effects of primary PCI on transmural dispersion of repolarization （TDR） in patients with ST-elevated myocardial infarction.Methods 341 cases with STEMI were enrolled and divided into revascularized group（n = 212） and unrevascularized group（n= 129）according to whether successful primary PCI was accomplished.Other cases who had no coronary heart disease constituted the control group（n = 36）.TDR was quantified as Tpeak-Tend/ RR^1/2,which was nominated as Tp-e/c.The Tp-e/c values in control group,revascularized group and unrevascularized group were compared,and the influential factors of reduction of Tp-e/c（pre-and post-primary PCI） were detected.Results Although Tp-e/c in unrevascularized group was much higher than that in control group,there was no significant difference of Tp-e/c at time of admission,and on 2nd day or 3rd day（P > 0.05）.There was no marked difference of Tp-e/c reduction at the above-mentioned time-points despite different infarction-related arteriesGRA,P> 0.05).Reduction of Tp-e/c had independent positive correlation to total ST-descent,CK-MB and cTnI;and had independent negative correlation to LVEF or Killip classification.Conclusion Acute STEMI is characterized by significantly increased TDR which sustains a high level on the first 3 days at least.Primary PCI is benificial to reduction of TDR.Reduction of Tp-e/c is related to ST-descent,serum level of myocardial markers and left ventricular systolic function,while has nothing to do with different IRA.更多还原