急性ST抬高心肌梗死心电图心肌缺血分级的临床意义

被引：10

作者：

张晓雷 ^{[1
,2
]}

王荣英 ^{[1
]}

田英平 ^{[1
]}

牛丽伟 ^{[3
]}

王艳芬 ^{[1
]}

机构：

[1] 河北医科大学第二医院急诊科

[2] 天津港口医院急诊科

[3] 开滦唐家庄医院内科

来源：

临床荟萃 | 2012年 / 27卷 / 12期

关键词：

心肌梗死; 心肌缺血; 心室功能; 心电描记术; 超声心动描记术;

D O I：

暂无

中图分类号：

R542.22 [];

学科分类号：

摘要：

目的通过对急性ST段抬高心肌梗死患者入院时心电图QRS波群变化进行缺血分级,探讨缺血分级的临床意义。方法 STEMI患者105例,根据入院时心电图QRS波群变化进行缺血分级:2级缺血组(56例);3级缺血组(49例)。所有患者于梗死后2周行99m锝-甲氧基异丁基异腈(99mTc-MIBI)心肌灌注断层显像(SPECT)和99m锝-红细胞(99mTc-RBC)心血池显像,测定心肌梗死面积和心功能;住院期间观察并发症的发生率。结果入院时心电图,3级缺血组ST段抬高的幅度(∑ST)显著大于2级缺血组(0.75±0.56)mV vs(0.50±0.32)mV,肌酸激酶同工酶(338±112)U/L vs(178±92)U/L和肌钙蛋白峰值(21.4±11.0)μg/L vs(9.2±5.4)μg/L显著高于2级缺血组(P<0.05),心肌梗死面积大于2级缺血组(18.82±8.76)%vs(14.75±6.24)%(P<0.05),而左心室射血分数低于2级缺血组(P<0.05);在住院并发症包括心律失常发生率、心力衰竭或心源性休克的发生率、住院病死率、室壁瘤发生率方面,3级缺血组均显著高于2级缺血组(P<0.05);而再梗死发生率,3级缺血与2级缺血组间差异无统计学意义(P>0.05)。结论入院时心电图呈3级缺血的急性STEMI患者心肌梗死面积大,心功能和预后差,需要采取更加积极的治疗措施。

引用

页码：1018 / 1020+1024 +1024

页数：4

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