急性脑梗死缺血性心电图改变的临床意义探讨

Study on the Clinical Significance of Ischaemic ECG Changes in Acute Cerebral Infarction

目的评估急性脑梗死患者缺血性心电图改变的发生率,探讨缺血性心电图改变在评价急性脑梗死患者预后方面的重要性。方法选择2006年6月—2007年12月收治入院的320例急性脑梗死患者,分为两组:缺血性心脏病组(214例)和非缺血性心脏病组(106例)。年龄42～86岁,在入院时记录所有患者标准12导联心电图,回顾性分析缺血性心电图改变与急性脑梗死后一年内死亡危险的关系。结果196例(61.2%)的急性脑梗死患者有一项或多项缺血性心电图改变。其构成为ST段压低91例(28.4%),T波倒置100例(31.3%),异常Q波38例(11.9%)和ST段抬高14例(4.4%)。106例(33.1%)既往无缺血性心脏病。缺血性心脏病组的死亡率34例(15.9%)与无缺血性心脏组的死亡率(4.7%)相比显著增高。死亡组与生存组相比缺血性心电图改变发生率显著增高,包括异常Q波、ST段压低、T波倒置。结论缺血性心电图改变在急性脑梗死患者普遍存在,这些变化倾向由于既往缺血性心脏病而不是急性脑梗死状态本身引起。缺血性心电图改变可能是急性脑梗死后死亡的一个预测因素。

Objective Acute cerebral infarction is associated with electrocardiographic （ECG） changes. Some of these changes have been thought to be due either to the stroke state itself or pre - existing heart disease. Methods The aims of the present study were to assess the prevalence of ischaemic ECG changes in acute cerebral infarction in order to determine ischae- mic ECG changes prognostic importance. Methods Patients with acute cerebral infarction who were 42 to 86 years old during June 2006 through December 2007 were analyzed （n = 320）. A 12 -lead ECG was recorded in all patients at admission. The authors investigated the association between ischaemic ECG changes and the risk for death after cerebral infarction over a 1 - year period. Results 196 （61.2%） of the patients had ischemice ECG changes in one or more of the ECG items made up of ST depressiongl （28.4%）, T-wave inversionl00 （31.3%）, Q-waves38 （11.9%） and ST elevation 14 （4.4%）. 106 （33.1%） of the patients had no pre-existing ischaemic heart disease. Mortality rate of ischaemic heart disease at 15.9% was significantly higher than in those without schaemic heart diseaseat at 4. 7%. The presence of Q - waves, ST depression, T - wave inversion were significantly higher in patients who died than in patients who survived. Conclusion Isehemic ECG changes are common in our patients with acute cerebral infarction. These changes tend to be due to pre - existing ischemice heart disease rather than the stroke state. Ischemic ECG changes could be a predictive factor for death after acute cerebral infarction.