急性非Q波心肌梗死53例临床分析

Clinical analysis of 53 patients with Non-Q wave acute myocardial infarction

目的 :探讨急性非 Q波肌梗死 (NQA MI)诊断标准及不同心电图类型患者的预后。方法 :回顾性分析我院临床诊断为 NQAMI的 5 3例住院患者的临床特点及随访结果。结果 :NQAMI无典型胸痛或心肌酶正常者常见 ,分别为 2 2 .6% ,3 2 .3 %。不同心电图类型的 NQAIM患者预后不同。 T波倒置型 (T波型 ) NQA MI急性期病死率 0 ,2年累积病死率 2 5 .0 % ,再梗死率 12 .5 % ,均明显低于 ST段压低型 (ST型 )的 14 .2 % ,3 8.1% ,3 8.9%及 ST段压低并 T波倒置型 (ST-T型 )的12 .5 % ,3 7.5 % ,3 8.1%。同期急性 Q波型心肌梗死 (Q AMI)住院患者分别为 17.5 % ,2 5 .3 % ,13 .8%。结论 :无典型胸痛或心肌酶正常不能完全排除 NQAMI诊断。 ST型及 ST-T型 NQ AMI患者近期及远期预后均较 T波型者差 ,但近期预后较Q AMI好 ,而远期预后较 QA MI差。

Objective: It is to explore the diagnosis standard of Non Q wave acute myocardial infarction (NQAMI) and the outcome of the NQAMI patients with various kinds of ECG. Methods: The clinical special feature and the follow up result of 53 patients with NQAMI in our hospital were retrospectively analyzed. Results: The NQAMI patients with no chest pain or with normal plasma myocardial enzyme level were ordinary, the percentages were 22.6% and 32.3% respectively. The outcomes of NQAMI patients with various kinds of ECG were different. The case fatality rate of NQAMI patients with converse T wave was 0, and the case fatality rate of two years was 25.0%. The reinfarction percentage was 12.5%. The three kinds of percentages were lower than those of patients with ST segment pressed (14.2%, 38.1%, 38.9%) and those of patients with ST segment pressed and converse T wave (12.5%, 37.5%, 38.1%). The beyond three kinds of percent ages with Q wave acute myocardial infarction were 17.5%, 25.3%, 13.8%. Conclusion: The patients with no chest pain or with normal plasma myocardial enzyme level can't be completely depart the NQAMI. The short term outcome and the long term outcome of the NQAMI patients with T style were better than those of patients with ST style and ST T style. The short term outcome of the NQAMI patients with ST style and ST T style is better than that of QAMI patients, but the long term outcome is bad than that of QAMI patients.