急性心肌梗死“墓碑样”ST段改变的临床意义

Clinical significance and prognosis of "tombstoning" of ST segment in acute myocardial infarction

目的：探讨急性心肌梗死（AMI）时，"墓碑样"ST段改变的临床意义和预后。方法：48例AMI患者，根据ST段形态分为墓碑样组（n=11）和对照组（n=37）。比较两组间ST段上抬高度、ST段抬高导联数、CK峰值、QT离散度、心脏严重并发症例数和死亡率以及广泛心肌梗死（ST段抬高导联数＞5个）的发生例数。结果：除广泛心肌梗死的例数二组之间比较无差异（P＞0.05）外，墓碑样组均大于对照组，差异显著（P＜0.05）。墓碑样组室性心律失常的发生率和由此引起的死亡数亦大于对照组（P＜0．05）。结论：有"墓碑样"ST段改变者预后较差，与心肌梗死范围相比，心肌缺血损伤程度较重可能是其预后不良的更重要原因。

Objective: For the invesligation of the clinical significance of 'tombstoning' of ST segment in AMI and its relation to prognosis. Methods: According to the shape of the ST segment, 48 patientswith AMI were divided into two groups: the tombstoning group (n = 11), and the control group (n = 37).The magnitude of ST elevation, QT interval dispersion, the number of cardiac complications, mortality and thenumber of cases with large - size infarct (the number of leads ST segment elevation > 5) in the tombstoninggroup were compared with those in the control. Results: The values of all the above items in the tombstoninggroup were significantly higher than those in the control (P < 0.05 ) except for the number of cases with large- size infarct (P > 0.05). A higher rale of ventricular arrhythmia (VA) and more deaths caused by VA inthe tombstoning group were observed more frequently than in the control, (P < 0.05) Conclusion: Patientswith tombstoning ST segments are usually poor in prognosis and severe myocardial ischemic injury might be amore important factor for poor prognosis than large - size infarct in these patients.