急性冠状动脉综合征心电图改变的临床意义  

Clinical significance of electrocardiogram changes in acute coronary artery syndrome

作　　者：董小玲[1] 李仁君[1] 潘伟民[2] 

机构地区：[1]浙江省宁波市第一医院心电科,315010 [2]浙江省宁波市第一医院心内科,315010

出　　处：《心电学杂志》2002年第1期13-16,共4页Journal of Electrocardiology(China)

摘　　要：目的探讨急性冠状动脉综合征心电图改变的临床意义。方法对104例接受经皮穿刺腔内冠状动脉成形术加支架植入术的急性冠状动脉综合征患者 (Ⅰ组Q波心肌梗死54例、II组非Q波心肌梗死12例和Ⅲ组不稳定心绞痛38例 )的冠状动脉病变和心电图改变进行分析。结果冠状动脉完全闭塞I组占75 .55 % ,II组占33 .33 % ,差异有显著性意义(P<0.05)。III组无冠状动脉完全闭塞。3组冠状动脉多支病变差异无显著性意义 (P>0.05)。Ⅰ组 :前壁心肌梗死多于下壁(32/54∶22/54) ,发生持续性窦性心动过速、三度房室传导阻滞、室性心律失常、死亡率高。Ⅱ组 :广泛持续性ST_T改变或以T波深倒置演变特征或Q波迅速消失 ,ST_T动态改变。III组 :胸痛发作时ST_T改变或伪性改善 ,不发作时ST_T正常或仍有改变。结论急性冠状动脉综合征心电图表现有多种形式。无Q波心肌梗死并不少见。心电图的易变性是急性冠状动脉综合征的特征之一。Objective To explore clinical significance of ECG changes in acute coronary artery syndrome (ACS). Methods One hundred four patients who accepted primany PTCA and stent implantation were divided into three groups:group Ⅰ( Q _ wave myocardial infarction, 54 cases);group Ⅱ(non Q _ wave myocardial infarction, 12 cases) and groupⅢ (unstable angina ,38 cases), coronary artery lesions and ECG changes were analysed. Results Coronary artery total occlusions were found in 75.55% patients in group I and 33.33%in group II ,having dramatic significance in difference(P<0.05), and none in groupⅢ .There was no significance of multivecoronary lesions in three groups.In group I there were more anterior myocardial infarction (MI) than inferior MI (32/54:22/54).Continual sinus tachycardia,arterioventricular block(Ⅲdegree)and ventricular arrhythmia predicted high mortality. ECG in group Ⅱ showed extensive continual changes of ST _ T or evolution of T _ waves with deep inversion or ST _ T evolution with transient Q _ wave.ECG in groupⅢ showed ST _ T changes or pseudo _ improved during chest pain and normal or changed ST _ T after chest pain. Conclusion There are many kinds of ECG changes in ACS.Non _ Q _ wave myocardia1 infarction doesn't seldom Occur.Lability of ECG is one of characters in ACS.

关 键 词：Q波心肌梗死 无Q波心肌梗死 不稳定型心绞痛 冠状动脉造影 心电图 急性冠状动脉综合征 临床意义 

分 类 号：R540.41[医药卫生—心血管疾病]