12导联心电图联合心肌酶谱检测对不典型心肌梗死的诊断价值

摘要

目的:探讨12导联心电图联合心肌酶谱检测对不典型心肌梗死的诊断价值.方法:选取医院收治的80例不典型心肌梗死患者纳入观察组,另选同期收治的80例典型心肌梗死患者纳入对照组.两组均使用福田FX-8322心电图仪进行常规12导联心电图检查,记录Q波及ST段改变;使用AU2700型全自动生化分析仪检测血清心肌酶谱指标:肌酸激酶(CK)、同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)水平.比较两组患者首发症状、心电图特征、心肌酶谱检测结果及诊断准确率.结果:观察组80例患者中首发症状无痛占20.0%、不典型疼痛占75.0%,典型上腹部+胸背部疼痛占5%;对照组80例患者全部为典型上腹部+胸背部疼痛,占100.0%,两组比较差异有统计学意义(x2=8.889,x2=48.000,x2=72.381;P＜0.05).心电图特征,观察组80例患者中无ST-T段改变占22.5%,无病理性Q波+T波直立+ST段抬高占17.5%,病理性Q波+T波倒置+ST段弓背抬高占60.0%;对照组80例患者全部为病理性Q波+T波倒置+ST段弓背抬高,占100.0%,两组比较差异有统计学意义(x2=10.141,x2=7.671,x2=20.000;P＜0.05).心肌酶谱检测,观察组血清CK、CK-MB和cTnI水平均显著低于对照组,两组比较差异有统计学意义(t=59.766,t=20.735,t=13.352;P＜0.05).观察组心电图诊断准确率为87.5%,显著低于对照组的100.0%,两组比较差异有统计学意义(x2=5.333,P＜0.05).观察组心电图联合心肌酶谱诊断准确率为100.0%,与对照组比较差异无统计学意义.结论:12导联心电图诊断典型心肌梗死效果良好,但对于不典型心肌梗死需联合心肌酶谱检测,以提高诊断准确率.%Objective: To explore the diagnostic value of 12 leads electrocardiogram (ECG) combined with detection of myocardial enzyme spectrum for atypical myocardial infarction. Methods: 80 patients with atypical myocardial infarction were enrolled in the observation group, and 80 patients with typical myocardial infarction in the same period were enrolled in the control group. Both of two groups were implemented the routine 12 leads ECG examination using FX-8322 ECG instrument, and the changes of Q wave and ST segment were recorded. And the series of indicators of serum myocardial enzymes (CK, CK-MB and cTnI) were detected by using AU2700 automatic biochemical analyzer. The test results of the first symptoms, ECG characteristics, myocardial enzyme spectrum and diagnostic accuracy of the two groups were compared. Results: In 80 patients of observation group, the painless first symptom was 20%, and the atypical pain was 75%, the typical upper abdominal and back pain accounted for 5%. In 80 patients of control group, all of them were typical upper abdominal and back pain, and the differences of these indicators between the two groups were significant (x2=8.889, x2=48.000, x2=72.381, P<0.05). For characteristics of ECG, the 22.5% of 80 patients of observation group hasn't been changed at ST-T segment, and the 17.5% of them was no pathological Q wave +T wave erect +ST segment elevation, and the percentage of pathological Q wave +T wave erect +ST segment elevation in observation group was 60.0%. On the other hand, the 100.0% of 80 patients of control group was pathological Q wave+T wave inverted +ST segment elevation, the differences of these indicators between the two groups were significant (x2=10.141, x2=7.671, x2=20.000, P<0.05). The results of myocardial enzyme spectrum detection indicated that the levels of serum CK, CK-MB and cTnI in the observation group were significantly lower than those in the control group (t=59.766, t=20.735, t=13.352, P<0.05), respectively. The diagnostic accuracy rate of ECG in observation group was 87.5%, which was significantly lower than 100% in control group (x2=5.333, P<0.05). The accuracy rate of ECG combined with myocardial enzyme spectrum in the observation group was 100%, which was not statistically significant compared with that in control group. Conclusion: 12 leads ECG is effective in diagnosing typical myocardial infarction, but it is necessary to combine myocardial enzyme spectrum detection for atypical myocardial infarction so as to increase the diagnostic accuracy rate.