ST段抬高与非ST段抬高的成人急性心肌炎临床特点比较  

Clinical features comparison of ST segment elevation and non ST segment elevation in adult patients with acute myocarditis

作　　者：宁尚秋[1] 尼玛 伊比然恨 刘文娴[1] 任燕龙[1] 何卫红[1] 康铁朵[1] 吕树铮[1] 

机构地区：[1]首都医科大学附属北京安贞医院·北京市心肺血管疾病研究所心内科、心血管疾病精准医学北京实验室,北京100029 [2]拉萨市人民医院心内科

出　　处：《中华急诊医学杂志》2017年第6期697-702,共6页Chinese Journal of Emergency Medicine

基　　金：首都卫生发展科研专项项目（首发2016-3-7031）

摘　　要：目的探讨心电图以ST段抬高为表现的成人心肌炎的临床特点，为临床诊治提供参考。方法回顾性分析2002年1月至2015年12月北京安贞医院诊断为急性心肌炎的年龄超过18周岁的患者共105例，分为两组，一组心电图以ST段抬高为表现（ST段抬高组）共57例，另一组心电图以非ST段抬高为表现（非ST段抬高组）共48例，比较两组的临床特点、实验室及辅助检查、治疗方式及转归等。住院期间主要心脏不良事件包括死亡，心源性休克和室颤。结果ST段抬高组与非ST段抬高组急性心肌炎患者平均年龄相似[（27.7±10.1）岁和（28.7±10.0）岁，P值＝0.603]。与非ST段抬高组相比，ST段抬高组急性心肌炎患者入院时心率[（89±22）次/min和（80±23）次/min，P＝0.028]、入院时收缩压[（105±17）mmHg和（115±17）mmHg，P＝0.003]和入院时舒张压[（66±11）mmHg和（74±11）mmHg，P＝0.000]差异均有统计学意义。ST段抬高组中表现为急性暴发性心肌炎的患者有20例（35.1%），非ST段抬高组有7例（14.6%），两组相比差异具有统计学意义（P值＝0.024）。住院期间主要心脏不良事件（包括死亡、心源性休克和室颤）在ST段抬高组为10例（17.5%），非ST段抬高组没有病例发生，两组相比差异具有统计学意义（P＝0.002）。结论心电图表现为ST段抬高的急性心肌炎，发病急，病情重且进展迅速，住院期间主要心脏不良事件发生率相对较高，病情危重，应引起临床医师高度重视，及时采取维护生命体征的治疗措施。Objective ST segment elevation in adult patients with acute myocarditis is rare in adult. The purpose of this study was to report the outcome of ST segment elevation in adult patients with acute myocarditis in our hospital, in order to provide reference for clinical diagnosis and treatment. Methods A retrospective analysis of Beijing Anzhen Hospital during January 2002 to December 2015 for the diagnosis of acute myocarditis were 105 cases , divided into two groups, one group of ST elevation （ST elevation group） total 57 cases, another group of non ST elevation （ non ST elevation group ） total 48 cases. The clinical features, laboratory examination, treatment and prognosis were compared between the two groups. The composite primary endpoint of major cardiovascular events （MACE） during hospitalization included： mortality, cardiac shock and ventricular fibrillation. Results The average onset age of patients with ST segment elevation group and non ST segment elevation group were similar [ （ 27.7± 10. 1 ） years vs.（28.7 ± 10.0） years , P = 0. 603 ] . There was a significant difference between the two group in patients of heart rate [ （89 ± 22 ） beats/rain vs. （ 80 ±23 ） beats/rain , P = 0. 028 ] , systolic blood pressure on admission [ （ 105 ± 17 ） mmHg vs. （ 115±17 ） mmHg, P = 0. 0031, diastolic blood pressure on admission [ （66 ± 11 ） mmHg vs. （74 ± 11 ） mmHg, P = 0. 000 ], and total number of acute fulminant myocarditis [20 （35. 1% ） vs. 7 〈 14. 6% ）, P = 0. 024） ] . ST segment elevation acute myocarditis patients were significantly more at risk for MACE than non ST segment elevation acute myocarditis patients during hospitalization （P = 0. 04） . Conclusion ST segment elevation acute myocarditis has acute onset and rapid progression. The incidence of MACE during hospitalization was significantly high. Mechanical support can be very favourable. ST segment elevation acute myocarditis is associated with excellent short-term prognosis.

关 键 词：成人 急性心肌炎 ST段抬高 临床特点 主要心脏不良事件 死亡 心源性休克 室颤 

分 类 号：R542.21[医药卫生—心血管疾病]