78例ST段抬高型心肌梗死超急性期心电图分析

Electrocardiographic characteristics of ST-segment elevation myocardial infarction in super-acute phase： clinical analysis of 78 cases

目的 分析ST段抬高型心肌梗死（STEMI）超急性期心电图表现.方法 78例我院急救中心收住的超急性期STEMI患者,均在发病后10 min～2 h内进行了18导联心电图记录,而后都经心肌损伤标志物和/或冠状动脉造影明确诊断.对所记录到的心电图进行分析.结果 78例超急性期患者中急性前壁29例（37.2%）,前间壁19例（24.4%）,急性前壁侧壁15例（19.2%）,急性下壁9例（11.5%）,急性前壁合并下壁6例（7.7%）,心电图中出现T波高尖52例（66.7%）,ST段抬高47例（60.3%）,急性损伤阻滞27例（34.6%）,缺血性J波21例（26.9%）,无明显变化5例（6.4%）,室性心律失常37例,室性心律失常的发生率J波组明显高于无J波组（P〈0.05）.结论 超急性期STEMI患者心电图可出现缺血性J波、T波高尖、ST段抬高、急性损伤阻滞,也可无明显变化（假性正常化）,缺血性J波是急性心肌缺血的新指标,缺血性J波的出现常提示心电活动不稳定,易发生室性心律失常.

Objective To investigate the electrocardiographic characteristics of ST - segment elevation myocardial infarction （STEMI） in the super - acute phase. Methods Seventy - eight super - acute ST - segment elevation myocardial infarction patients, 62 males and 16 females, aged 57.3 （ 33 84）, underwent first aid in emergency center and then inpatient treatment in our hospital. All the patients received dynamic 18 standard leads electrocardiography within 10 minutes to 2 hours after attack. The diagnosis of STEMI was confirmed by cardiac markers and/or coronary angiography. The electrocardiographic characteristics were analyzed. Results Of the 78 cases, 29 cases （37.2%） were diagnosed as acute anterior myocardial infarction, 19 cases （24.4%） as anteroseptal infarction, 15 cases （ 19. 2% ） as anterior wall and wall myocardial infarction, 9 cases （ 11. 5% ） as inferior myocardial infarction, and 6 cases （7.7%） as anterior myocardial infarction complicated with inferior myocardial infarction. In initial electrocardiogram, fifty- two cases （66.7%） showed high, sharp, broad T wave. Forty - seven cases （60. 3% ） showed oblique and upward ST segment elevation. Twenty- seven cases （34.6%） showed acute injury block. Twenty- one cases （26.9%） showed ischemic J wave. Five cases showed pseudo - normalization. Thirty - seven cases had ventricular arrhythmia. Ventricular arrbythmia incidence was obviously higher in J wave group than in the group without J wave （ P 〈 0.05 ）. Conclusion Ischemic J wave and high, sharp, broad T wave, upward ST segment elevation, acute injury block, pseudo - normalization are seen in the ECG of STEMI in the superacute phase. Ischemic J wave, as a new index of acute myocardial ischemia, indicates the instability of heart and the occurrence of ventricular arrhythmia.