急性心肌梗死墓碑型心电图改变的临床意义

Clinical significance of "tombstoning" electrocardiographic pattern in patients with acute myocardial infarction

目的探讨急性心肌梗死（AMI）墓碑型心电图改变的临床意义。方法114例AMI患者入院后根据ST段抬高的类型分为2组：A组：ST段抬高呈墓碑型;共20例,B组：ST段抬高呈非墓碑型,包括弓背向上型、斜直型、新月型或平顶型,共94例,对比分析2组住院期间主要心脏不良事件的发生情况。结果A组ST段抬高AMI住院期间Ⅲ~Ⅳ级心功能患者、死亡率均超过B组（P〈0.005）。心源性休克及急性左心衰的发生率也明显高于B组（P〈0.005）。结论墓碑型ST段抬高AMI患者左心功能受损严重,泵衰竭发生率及死亡率高,临床预后差。ST段抬高呈斜直型、新月型或平顶型AMI临床预后相对较好。

Objective To explore clinicial significance of ＂ tombstoning＂ electroeardiographie pattern in patients with acute myocardial infarction. Methods 114 patients were divided into 2 groups according to ST segment elevation pattern：20 cases in group A showing ＂tombstoning＂ of ST segment elevation pattern and 94 patients in group B showing dome-shaped segment or seoope appearance or oblique straightening patterns. The major adverse eardiae event （ MACE ） was analyzed in the two groups. Results The baseline characteristics of the two groups were similar except that group A were almost anterior wall acute myocardial infarction. Patients of group A had a greater incidence of the left ventrieular function failure [ killip Ⅲ - Ⅳ ） and death rate. Patients of group A had a greater incidence of cardiac shock. Conclusion There is significantly higher incidence of MACE in patients of ＂ tombstoning＂ pattern. The left ventricular function decreases in patients with ＂ tombstoning＂ electrocardiographic pattern.