急性脑卒中患者异常宽大T波心电图的临床意义探讨

Clinical Significance of Abnormal Wide T Waves on ECGs in Patients with Acute Stroke

目的探讨急性脑卒中患者心电图异常宽大T波的发生情况及临床意义。方法依据心电图纳入标准,从2 580例急性脑卒中患者中筛选出53例为宽大T波组,2 527例为非宽大T波组,统计头部CT或MRI、DWI检查结果,肌钙蛋白(cTnT)、磷酸肌酸激酶同工酶(CK-MB)、N末端B型利钠肽原(NT-proBNP)、电解质、超声心动图、临床转归等临床指标。结果 2 580例急性脑卒中病例的异常宽大T波发生率为2.05%,其中546例蛛网膜下腔出血患者发生率为6.59%,724例脑出血患者发生率为1.24%,1 310例脑梗死患者发生率为0.61%。cTnT、CK-MB增高在宽大T波组的发生率分别为92.45%、86.79%,非宽大T波组分别为11.20%、10.00%,组间差异有统计学意义(均P<0.01)。宽大T波组与非宽大T波组的住院病死率分别为22.64%、4.50%(P<0.01),女性宽大T波多于男性。结论异常宽大T波多发生于蛛网膜下腔出血患者,颅内压显著增高、儿茶酚胺性心肌损害程度较重可能是引起异常宽大T波的主要原因,异常宽大T波可在一度程度上反映卒中患者的病情严重性。

Objective To investigate the incidence and clinical significance of the abnormal wide T waves on ECG in pa‐tients with acute stroke.Methods A total of 2 580 patients with acute stroke were enrolled according to the results of ECG. They were divided into wide T wave group （53 cases）and non‐wide T wave group（2 527 cases）.Clinical data were collect‐ed including head CT ,MRI ,DWI results ,clinical indexes such as troponin（cTnT） ,creatine kinase isoenzyme（CK‐MB） ,N termi‐nal B type natriuretic peptide（NT‐proBNP） ,electrolytes ,echocardiogram and clinical outcome.Results The incidence of abnor‐mal wide T waves was 2.05% in 2 580 cases of acute stroke ,and it was 6.59% in 546 patients with subarachnoid hemorrhage , 1.24% in 724 patients with cerebral hemorrhage ,0.61% in 1 310 patients with cerebral infarction. The incidences of increased cTnT and CK‐MB were 92.45% ,86.79% in wide T wave group and 11.20% ,10.00% in non‐wide T wave group ,respective‐ly.The in‐hospital mortality was 22.64% ,4.50% in the two groups respectively（P〈0.01）.Women were more likely than men to have abnormal wide T waves.Conclusion Abnormal wide T waves mainly occurred in patients with the subarachnoid hemor‐rhage. The intracranial hypertension and catecholamine‐induced myocardial damage may be the main reasons for abnormal wide T waves.Abnormal wide T waves can reflect the severity of stroke to some extent.