急性心肌梗死“墓碑样”ST段改变的临床意义

Clinical significance of "Tombstoning" of ST segment in Acute Myocardial Infarction

回顾性分析了1984～1995年急性心肌梗死146例,其中包括“幕碑样”ST段改变者19例(13.01％),1周内病死率63.15％。ST段“墓碑样”改变者预后差的临床因素是:梗死部位89.47％为前壁范围;nST、∑ST、nQ、∑Q均高于对照组,说明心肌损伤、坏死的范围和程度都较重,临床严重合并症多。“墓碑样”ST段改变者QTcd为(79.33±28.58)ms,较对照组明显增加。猝死者占死亡人数的66.67％。认为QTcd延长是ST段“墓碑样”改变组临床预后差的独立因素。

The analysis of 146 cases of acute myocardial infarction (AMI) showed that the death rate of 'tombstoning' of ST segment(n= 19)was 63- 15% within one week. The factor of the bad prognosis in the patients with 'tombstoning' was that 89. 47% of infarction area was in the anterior portion of the left ventricle,and nST,∑ST,nQ,∑Q levels and severe complications of 'tombstoning' cases were higher than those of the control group,which supported the notion of extensive and rapid myocardial damage and necrosis. QTcd of 'tombstoning' cases was(79. 33 ± 28. 58)ms that was significantly higher than the control group. The sudden cardiac death occupied 66. 67% of the mortality with 'tombstoning'. The study showed that the extended QTcd might be an independent factor of the poor prognosis.