非ST段抬高心肌梗死患者心电图新分类的临床意义  

Clinical value of new electrocardiogram classification for patients with non-ST elevated myocardial infarction

作　　者：宋慧慧[1] 张培荣[1] 楚英杰[1] 董淑娟[1] 余海佳 Song Huihui;Zhang Peirong;Chu Yingjie;Dong Shujuan;Yu Haijia(Department of Emergency,Henan Provincial People’s Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院急诊科,郑州450003

出　　处：《中国实用医刊》2022年第12期1-4,共4页Chinese Journal of Practical Medicine

基　　金：河南省重点科技攻关计划项目 (1221023100)。

摘　　要：目的探讨依据心电图对非ST段抬高心肌梗死(NSTEMI)患者进行新分类的临床意义。方法抽取2016年2月至2019年12月于河南省人民医院早期行急诊冠状动脉介入治疗的232例NSTEMI患者,依据心电图ST段有无偏移分为ST段压低组(154例)和ST段无偏移组(78例),分析两组患者的临床特征、冠状造影特点及主要心血管不良事件发生率。结果与ST段无偏移组比较,ST段压低组患者年龄偏大,女性相对多见,心肌梗死及糖尿病病史较常见(P<0.05)。冠状动脉造影结果显示,ST段无偏移组患者梗死相关动脉以回旋支多见,且病变部位多位于中远段。ST段压低组术前心肌梗死溶栓试验分级0、1级者比例及多支血管病变、侧支循环患者比例(50.8%,78/154;16.2%,25/154;68.2%,105/154;42.2%,65/154)均高于ST段无偏移组(23.1%,18/78;6.3%,5/78;37.2%,29/78;15.4%,12/78),P均<0.05。ST段压低组心力衰竭和心源性休克的发生率(10.4%,16/154;8.4%,13/154)高于ST段无偏移组(2.6%,2/78;1.3%,1/78),P<0.05。结论NSTEMI可依据心电图细分为ST段无偏移型和ST段压低型两类,为指导NSTEMI患者的危险分层及选择最佳的治疗方式提供理论依据。Objective To investigate the clinical value of the new electrocardingram(ECG)classification for patients with non-ST elevated myocardial infarction(NSTEMI).Methods A total of 232 patients with NSTEMI who underwent emergency coronary intervention in the early stage in Henan Provincial People’s Hospital from February 2016 to December 2019 were selected and divided into ST-segment depression group(154 cases)and non-ST-segment deviation group(78 cases)according to ST segment deviation in ECG.Clinical features,coronary angiographic features and incidence of major adverse cardiac events of the two groups were analyzed.Results Compared with the non-ST-segment deviation group,the ST-segment depression group had older patients and more women,and had more patients with history of myocardial infarction and diabetes(P<0.05).Results of coronary angiography showed that the infarction related artery was more common in circumflex branch,and the lesions were mostly located in the middle and distal segments in non-ST-segment deviation group.The ratio of preoperative thrombolysis in myocardial infarction 0 stage to 1 stage,multivessel disease ratio and collateral circulation ratio of the ST-segment depression group were 50.8%(78/154),16.2%(25/154),68.2%(105/154)and 42.2%(65/154),respectively,higher than 23.1%(18/78),6.3%(5/78),37.2%(29/78)and 15.4%(12/78)in the non-ST-segment deviation group(all P<0.05).The incidence of heart failure and cardiogenic shock in the ST-segment depression group were 10.4%(16/154)and 8.4%(13/154),respectively,higher than 2.6%(2/78)and 1.3%(1/78)in the non-ST segment deviation group(P<0.05).Conclusions NSTEMI can be subdivided into two types according to ECG,non-ST segment deviation and ST segment depression.It can provide a theoretical basis for guiding the risk stratification and choosing the best treatment method of NSTEMI patients.

关 键 词：非ST段抬高心肌梗死 心电图新分类 

分 类 号：R542.22[医药卫生—心血管疾病]