急性颅脑损伤心电图误诊为急性心肌梗死临床分析

Clinical Analysis of Electrocardiogram in Acute Craniocerebral Injury Misdiagnosed as Acute Myocardial Infarction

目的研究分析急性颅脑损伤心电图误诊为急性心肌梗死的原因,为提高诊断准确率提供依据。方法选取我院2011年9月至2015年3月收治的77例急性颅脑损伤患者为研究对象,所有患者均接受心电图检查,观察心电图变化情况及急性心肌梗死误诊率。结果 77例急性颅脑损伤患者心电图异常主要表现为窦性心动过缓21例(27.27%)、ST段下移17例(22.08%)及T波低平或倒置16例(20.78%),巨大倒置T波13例(16.88%);共误诊为急性心肌梗死38例(49.35%),其中误诊为急性心内膜下心肌梗死20例(25.97%),误诊为急性透壁性心肌梗死18例(23.37%);77例颅脑损伤患者有66例心电图异常,按颅脑损伤治疗,有50例(75.76%)恢复正常心电图。结论对急性颅脑损伤患者进行诊断仅凭心电图容易误诊为急性心肌梗死,临床应结合其他检查及临床症状进行确诊。

Objective To investigate the reason of acute craniocerebral trauma electrocardiogram（ ECG）misdiagnosed as acute myocardial infarction and improve accuracy rate of diagnosis. Methods 77 cases with acute craniocerebral trauma in our hospital from September 2011 to March 2015 were selected and given electrocardiography,ECG changes and misdiagnosis rate were analyzed. Results Electrocardiographic abnormality of 77 cases with acute craniocerebral trauma mainly were： 21 sinus bradycardia（ 27. 27%）,17 ST segment depression（ 22. 08%） and 16 T wave flat or inverted（ 20. 78%）; and 13 cases of huge inverted T wave. 38 cases were misdiagnosed as acute myocardial infarction（ 49. 35%）,20 cases misdiagnosed as acute subendocardial myocardial infarction（ 25. 97%）,18 cases misdiagnosed as acute transmural myocardial infarction（ 23. 37%）; There were 66 cases with abnormal ECG in 77 craniocerebral injury patients,of which50 cases returned to normal（ 75. 76%） treated by craniocerebral trauma diagnosis. Conclusion The ECG of acute craniocerebral trauma may be misdiagnosed as acute myocardial infarction. In clinical practice,the diagnosis should be combined with other examination and clinical symptoms.