心电图在急性心肌梗死超急性期诊断中的应用

Application of ECG in diagnosing acute myocardial infarction in hyperacute phase

目的探讨心电图诊断急性心肌梗死（心梗）超急性期的临床价值。方法选择2013年1月至2015年1月经我院确诊的90例急性心梗超急性期患者,根据发病时间将其随机分为A、B、C三组,分别有患者55例、18例和17例,发病时间分别为≤2 h、2~6 h及6~8 h。对三组患者行24 h心电监测,详细记录各组心电图Q波、ST段和T波的变化情况,并统计分析阳性改变率。结果经24 h心电监测发现,所有患者的心电图阳性改变主要是Q波、ST段及T波的改变。其中,ST段及T波的改变诊断急性心梗超急性期的敏感性和特异性、阳性预测值与阴性预测值均高于Q波改变。三组的心电图阳性改变发生率依次为81.82%、38.89%和17.65%,A组均显著高于B、C组（P〈0.05）。A组患者中,ST段抬高型心梗者的心电图诊断阳性率显著高于非ST段抬高型心梗者（34.09%vs.18.18%,P〈0.05）。结论对急性心梗超急性期患者,尤其是发病2 h内的患者进行24 h心电监护,对准确判断病情和及时施治非常关键。T波宽大、高耸及ST段抬高可作为急性心梗超急性期的特征性心电图表现,为临床诊断和治疗提供参考依据。

Objective To investigate the clinical value of ECG in diagnosing acute myocardial infarction（ AMI） in hyperacute phase. Methods Ninety patients diagnosed with AMI in hyperacute phase by our hospital from January 2013 to January 2015 were selected. They were randomly divided into three groups： A（ 55 cases）,B（ 18 cases） and C（ 17 cases）,with onset time of ≤2 h,2- 6 h and 6- 8 h,respectively. Twenty-four-hour ECG monitoring was carried out on the three groups.The changes of Q-wave,ST-segment and T-wave were carefully recorded,and the rates of positive changes were made statistic analysis. Results It was observed by 24-hour ECG monitoring that positive ECG changes of all the enrolled cases were mainly Q-wave,ST-segment and T-wave changes. The sensitivity and specificity,and positive and negative predictive value of ST-segment and Twave changes were all higher than those of Q-wave changes in diagnosing AMI in hyperacute phase.The incidence of positive ECG changes among the three groups was 81. 82%,38. 89% and 17. 65%in turn,with the rate of group A significantly higher than that of group B and C（ P〈0. 05）. In the patients of group A,the diagnostic positive rate of ECG in the cases with ST-segment elevation myocardial infarction was significantly higher than that in non-ST-segment elevation myocardial infarction patients（ 34. 09% vs. 18. 18%,P〈0. 05）. Conclusion It is critical to carry out 24-hour ECG monitoring on AMI patients in hyperacute phase,especially those within 2 hours of onset,in order tomake accurate diagnosis and timely treatment. Wide and towering T-wave,and ST-segment elevation can be regarded as characteristic ECG manifestations of AMI in hyperacute phase,which provide references for clinical diagnosis and treatment.