急性心肌梗死超急性期心电图非典型改变的临床特点分析

Atypical ECG Changes of Acute Myocardial Infarction in Super-acute Phase

目的 总结急性心肌梗死（AMI）超急性期心电图非典型改变的临床特点,探讨其在AMI早期诊断中的意义.方法 回顾性分析2006年6月-2012年6月我科明确诊断为AMI的患者194例,其中男162例,女32例;年龄32～86岁,平均（59.9±7.1）岁.明确AMI患者超急性期心电图非典型改变的临床特点,并按就诊时间（visiting time,VT）的不同分为4组：0 h＜VT≤2 h组（25例）、2 h＜VT≤4 h组（54例）、4 h＜VT≤6 h组（55例）以及VT＞6 h组（60例）.分别记录各组Q波、R波、ST段以及T波的改变情况,并对各组的阳性改变率进行统计分析与比较.结果 4组间的性别、年龄及Killip分级情况比较,差异无统计学意义（P＞0.05）.心电图发生改变总阳性率为26.3%（51/194）,其中有Q波改变的占11.8%（6/51）,有R波改变的占17.6%（9/51）,有ST段改变的占25.5%（13/51）,有T波改变的占45.1%（23/51）.0 h＜VT≤2 h组、2 h＜VT≤4 h组、4 h＜VT≤6 h组以及VT＞6 h组的心电图阳性改变率分别为24.0%（6/25）、38.9%（21/54）、18.2%（10/55）以及23.3%（14/60）,差异有统计学意义（P＜0.05）;组间比较显示,2 h＜VT≤4 h组心电图阳性改变率均高于4 h＜VT≤6 h组和VT＞6 h组（ P＜0.05）,且2 h＜VT≤4 h组的阳性改变率最高（38.9%）.结论 AMI超急性期的心电图改变集中在发病的2 ～4 h,以T波改变多见;识别AMI超急性期的心电图临床特点,有助于及早诊断AMI,为临床提供帮助.

Objective To explore the clinical features of atypical ECG changes of acute myocardial infarction（AMI） in super-acute phase and its significance in early AMI diagnosis.Methods A retrospective analysis was performed on clinical data of 194 AMI patients[162 males,32 females,aged 32-86 years old,mean （59.9±7.1）years old] admitted to this hospital from June 2006 to June 2012.The patients were divided,according to visiting time（VT）,into groups A（0 h＜VT≤2 h,n=25）,B（2 h＜VT≤4 h,n=54）,C（4 h＜VT≤6 h,n=55）,D（VT＞6 h,n=60）.The changes of Q wave,R wave,ST segment and T wave were recorded and positive change rates of 4 groups analyzed and compared.Results There was no significant difference in gender,age,Killip grading between 4 groups（P＞0.05）.The total positive rate of ECG changes was 26.3%（51/194）,Q wave changes accounting for 11.8%（6/51）,R wave for 17.6%（9/51）,ST segment for 25.5%（13/51）,T wave for 45.1%（23/51）.The ECG positive change rates of groups A,B,C,D were 24.0%（6/25）,38.9%（21/54）,18.2%（10/55）,23.3%（14/60）,respectively,the difference was significant（P＜0.05）.The positive change rate was higher in group B than in groups C,D（P＜0.05）,and that of group B was the highest（38.9%）.Conclusion AMI ECG changes in super-acute phase focuses at hours 2-4,commonly T wave.Dialectical identification of the ECG clinical features of AMI in super-acute phase helps AMI early diagnosis.