墓碑型心电图改变急性前壁心肌梗死患者临床特点的探讨  

Study of clinical characteristics in patients with the "tombstoning" electrocardiographic pattern and anterior wall acute myocardial infarction

作　　者：张永珍[1] 刘祎秀[2] 李海燕[1] 高炜[1] 毛节明[1] 郭静萱[1] 陈明哲[1] 

机构地区：[1]北京大学第三医院心内科,北京100083 [2]承德医学院附属医院心内科

出　　处：《临床心血管病杂志》2004年第11期656-658,共3页Journal of Clinical Cardiology

基　　金：北京大学 2 11工程循证医学学科群 (No :930 0 2 4 6 15 6 0 77)

摘　　要：目的 :探讨墓碑型ECG改变与急性前壁心肌梗死 (AMI)临床表现之间的关系。方法 :2 0 0 1年 1月～ 2 0 0 3年 12月连续进行急诊冠状动脉介入诊疗的首次前壁AMI患者 2 0 3例 ,墓碑组 73例 ,非墓碑组 130例。对比分析两组一般特征、临床特征、冠状脉造影表现和血管重建方法。结果 :墓碑组肌酸激酶 MB峰值、住院并发症 (死亡、心力衰竭、心源性休克和心室颤动 )、经血运重建治疗 (溶栓和经皮冠脉介入治疗 )明显高于非墓碑组 (P<0 .0 5～ 0 .0 1) ;住CCU时间显著延长 ,LVEF明显降低 (P <0 .0 5 )。而典型症状、心绞痛史、心率、血压、血脂指标、血尿酸、血糖、急性肺水肿、室性心动过速、心房颤动、高度房室阻滞、住院总天数和冠状动脉造影特征两组间差异无统计学意义 (P >0 .0 5 )。结论 :在前壁首次AMI患者 ,墓碑型心电图改变者虽然再灌注治疗明显增多 ,但预后不良 。Objective:To explore the correlation between clinical manifestation and the 'tombstoning' electrocardiographic pattern in patients with anterior wall acute myocardial infarction (AMI). Method:The 203 consecutive patients with first anterior wall AMI underwent urgent cardiac catheterization between January 2001 and December 2003, 73 patients with typical tombstoning ECG pattern, and 130 patients with non-tombstoning. General characteristics, clinical characteristics, coronary angiographic findings, and revascularization were compared in two groups.Result:Tombstoning group had a higher prevalence of peak creatine kinase-MB, in-hospital complications (death, heart failure, cardiogenic shock, and ventricular fibrillation), and revascularization (thrombolysis and percutaneous coronary intervention) than non-tombstoning group (P< 0.05～ 0.01). Stay in coronary care unit was longer, but left ventricular ejection fraction was lower than those of non-tombstoning group (P< 0.05). There was a similar prevalence of typical symptoms, preinfarction angina, heart rate, blood pressure, plasma lipid level, uric acid, glucose, acute pulmonary edema, ventricular tachycardia, high grade atrioventricular block, stay in hospital, and angiographic findings in tombstoning group versus non-tombstoning group (P> 0.05). Conclusion:Tombstoning ECG pattern predicts a poorer outcome in the patients with first anterior wall AMI despite of more coronary revascularization, suggesting that tombstoning changes are more strongly associated with endothelium dysfunction and microvascular injury.

关 键 词：心肌梗死 心电描记术 预后 

分 类 号：R542.2[医药卫生—心血管疾病]