急性ST段抬高型心肌梗死心电图表现特征及临床价值研究

摘要

Objective:To explore the clinical electrocardiography(ECG)manifestations and application value in acute STEMI(ST-segment elevation myocardial infarction)patients.Methods:The clinical data about 116 STEMI patients treated from January 2016 to December 2017 in our hospital was reviewed.The subjects were divided into terminal QRS deformation(TQRSD)group(50 cases)and non-TQRSD group(66 cases).According to the general data,the ECG manifestations and death rate were observed.Results:The age,CK peak value,CK-MB peak value and ST-segment elevation lead frequency for TQRSD group were higher than non-TQRSD group;the time of starting from the disease attack to admission for TQRSD group was shorter than non-TQRSD group(P<0.05);the rate with Kill P>Grade One and death rate for TQRSD group(40.0%,20.0%)was higher than non-TQRSD group(13. 6%,12.1%)(P<0.05);the gender,complications,infarction position,ST-segment evaluation lead frequency and thrombolysis therapy for two groups were not significantly different(P>0.05);there were 94 cases of arrhythmia (81.0%),9 cases of atrial premature beats(7.8%),18 cases of paroxysmal supraventricular tachycardia(15.5%), 7 cases of paroxysmal atrial tachycardia(6.0%),9 cases of complete right bundle branch block(7.8%),29 cases of ventricular premature beat(25.0%)and 8 cases of atrial fibrillation(6.9%).Conclusion:The STEMI patients with TQRSD have the serious disease condition and poorer prognosis.However,the disease condition may be improperly and unclearly judged by the ECG.%目的:探讨急性ST 段抬高型心肌梗死(STEMI)心电图表现特征及临床价值.方法:116例S T EM I患者根据其心电图特征分为QRS终末扭曲、非Q RS终末扭曲组,分别为50例,66例,分析两组患者一般临床资料,并观察心电图特征及病死率的差异.结果:QRS终末扭曲组心肌梗死患者年龄、CK高值、CK-MB高值及ST 抬高导联数目高于非QRS终末扭曲组患者,其发病至入院时间低于非Q RS终末扭曲患者,两组比较均具有统计学差异(P<0.05);Q RS终末扭曲组心肌梗死患者Killp>1级率、病死率分别为40.0%、20.0% 高于非Q RS终末扭曲组的13.6%、12.1%,两组比较均具有统计学差异(P<0.05);两组患者在性别、合并症、梗死位置、ST 抬高导联数目、溶栓治疗方面无统计学差异(P>0.05);116例STEMI患者合并心律失常94例(81.0%),房性早搏9例(7.8%),阵发性室速18例(15.5%),阵发性房速7例(6.0%),完全性右束支阻滞9例(7.8%),室性早搏29例(25.0%),房颤8例(6.9%);伴有缺血性J波心肌梗死患者29例,其中室性心律失常19例,发生率为65.5%;无缺血性J波心肌梗死患者87例,其中室性心律失常30例,发生率为34.5%;伴有缺血性J波心肌梗死患者室性心律失常发生率为65.5% 高于无缺血性J波患者34.5%,两者比较具有统计学差异(P<0.05);心电图判断梗死血管与冠状动脉造影比较,判断正确99例,判断错误11例,无法判断6例.结论:心电图对STEMI患者梗死部位、病情及预后具有较高的评估价值,QRS终末扭曲STEMI患者病情较重、预后常不佳,但通过心电图判断梗死血管存在一定的误诊或无法判断.