心电图结合心肌酶谱评估非典型急性心肌梗死的临床价值  

Clinical value of electrocardiogram combined with myocardial enzymogram in evaluating atypical acute myocardial infarction

作　　者：许金芳 陈登 姜晓霞 XU Jinfang;CHEN Deng;JIANG Xiaoxia(Department of Function,The First Affiliated Hospital of Shihezi University,Shihezi,Xinjiang,832008,China;Department of Cardiology,The First Affiliated Hospital of Shihezi University,Shihezi,Xinjiang,32008,China)

机构地区：[1]石河子大学第一附属医院功能科,新疆石河子832008 [2]石河子大学第一附属医院心内二科,新疆石河子832008

出　　处：《新疆医学》2024年第4期410-414,共5页Xinjiang Medical Journal

基　　金：石河子大学第一附属医院临床研究基金(项目编号:LC202201)。

摘　　要：目的分析心电图(ECG)结合心肌酶谱评估非典型急性心肌梗死(AAMI)的临床诊断准确率。方法选取2019年6月-2021年12月在本院住院急诊科诊断AAMI患者45例与AMI患者45例。38例AAMI患者为AAMI组,45例AMI患者为AMI组。记录并比较两组患者临床症状、12导联ECG临床特征、心肌酶谱(CK、CK-MB、LDH和cTnT)、12导联ECG与ECG联合心肌酶谱的临床诊断准确率。结果AAMI组45例患者中无痛为20.00%高于AMI组(0.00%)(P<0.05);非典型疼痛占73.33%高于AMI组(0.00%)(P<0.05);典型上腹部+胸背部疼痛者为6.67%,低于AMI组(100.00%)(P<0.05)。AAMI组45例患者中无ST-T段改变为20.00%与无病理性Q波+T波直立+ST段抬高为17.78%,分别高于AMI组(0.00%、0.00%)(P<0.05);病理性Q波+T波倒置+ST段弓背抬高为62.22%,明显低于AMI组(100.00%)(P<0.05)。AAMI组的CK(327.59±14.73)IU/L、CK-MB(55.95±7.79)IU/L和cTnT(0.45±0.09)μg/L水平明显低于AMI组(465.42±24.15 IU/L、98.22±9.43 IU/L、0.72±0.14μg/L)(P<0.05);而LDH(435.99±115.42)IU/L水平明显高于AMI组(245.55±54.78 IU/L)(P<0.05)。AAMI组45例患者中ECG诊断准确率为82.22%,明显低于AMI组(100.00%)(P<0.05);同时AAMI组采用ECG结合心肌酶谱诊断准确率为100.00%,明显高于ECG(82.22%);而AAMI组与AMI组采用ECG联合心肌酶谱诊断准确率均为100.00%,比较无差异(P>0.05)。结论AMI与AAMI患者在临床症状、ECG临床特征与心肌酶谱存在显著差异,而单纯ECG诊断AAMI的临床诊断准确率较低,ECG结合心肌酶谱可以有效的提高诊断AAMI患者的诊断准确率。Objective To analyze the accuracy of clinical diagnosis of atypical acute myocardial infarction(AAMI)by combining electrocardiogram(ECG)and myocardial enzymogram.Methods From June 2019 to December 2021,45 patients with AAMI and 45 patients with AMI diagnosed in the inpatient emergency department of our hospital were selected into this study.38 patients with AAMI were in the AAMI group and 45 patients with AMI were in the AMI group.Clinical symptoms,clinical features of 12-lead ECG,myocardial enzyme profiles(CK,CK-MB,LDH and cTnT),and clinical diagnostic accuracy of 12-lead ECG and ECG combined myocardial enzyme profiles were recorded and compared between the two groups.Results The painless rate of 45 patients in AAMI group was 20.00% which was higher than that in AMI group(0.00%)(P<0.05).The proportion of atypical pain was 73.33% which was higher than that of AMI group(0.00%)(P<0.05).The rate of typical upper abdomen,chest and back pain was 6.67%,which was lower than that of AMI group(100.00%)(P<0.05).In 45 patients of AAMI group,20.00% had no ST-T segment change and 17.78%had no pathological Q wave combined with T wave upright and ST segment elevation,which were higher than those of AMI group(0.00% and 0.00%,respectively)(P<0.05).Pathological Q wave combined with T wave inversion and ST segment arch elevation was 62.22%,which was significantly lower than that in AMI group(100.00%)(P<0.05).The level of CK(327.59±14.73)IU/L,CK-MB(55.95±7.79)IU/L and cTnT(0.45±0.09)μg/L in AAMI group was significantly lower than those of AMI group(465.42±24.15 IU/L,98.22±9.43 IU/L,0.72±0.14μg/L)(P<0.05).The LDH(435.99±115.42)IU/L levels were significantly higher than those in AMI group(245.55±54.78 IU/L)(P<0.05).The accuracy rate of ECG diagnosis in 45 patients in AAMI group was 82.22%,which was significantly lower than that in AMI group(100.00%)(P<0.05).At the same time,the diagnostic accuracy of ECG combined with myocardial enzymogram in AAMI group was 100.00%that was significantly higher than that of ECG(82.22%);The di

关 键 词：非典型急性心肌梗死 急性心肌梗死 心电图 心肌酶谱 准确率 

分 类 号：R540.4[医药卫生—心血管疾病]