成人暴发性心肌炎早期心电图特点分析

Early electrocardiogram characteristics of fulminant myocarditis in adults

目的:探讨成人暴发性心肌炎的早期心电图特点。方法:回顾性纳入2002年1月至2018年2月于北京积水潭医院心内科诊断为成人急性病毒性心肌炎的61例患者,根据临床诊断分为暴发性心肌炎组(n=11)和非暴发性心肌炎组(n=50),比较两组患者入院48h内的心电图特点。结果:暴发性心肌炎组ST段抬高、T波倒置的导联数量明显大于非暴发性心肌炎组,Ⅱ导联QRS波振幅明显低于非暴发性心肌炎组,室性心动过速的比例明显高于非暴发性心肌炎组(P均<0.05)。暴发性心肌炎组PR间期、QRS间期较非暴发性心肌炎组延长,一度房室传导阻滞、三度房室传导阻滞、右束支传导阻滞的比例明显高于非暴发性心肌炎组(P均<0.05)。结论:在暴发性心肌炎患者中,PR间期延长、QRS间期增宽、QRS波低电压、一度房室传导阻滞、三度房室传导阻滞、右束支传导阻滞、室性心动过速等早期心电图表现明显多于非暴发性心肌炎患者,这些心电图表现对早期识别暴发性心肌炎有重要意义。

Objective：To analyze the early electrocardiogram（ECG）characteristics and clinical significance of fulminant myocarditis. Methods：Medical records from 61 adults patients who were diagnosed with acute viral myocarditis from January 2002 to February 2018 in Beijing Jishuitan hospital were retrospectively reviewed,and they were divided into the fulminant group（n=11）and nonfulminant group（n=50）.The early electrocardiogram characteristics within48 h and clinical significance were analyzed. Results：The numbers of leads of ST segment elevation and T wave inversion in fulminant group were more than those in non-fulminant group（both P〈 0.05）.The QRS amplitude of lead Ⅱin fulminant group was significantly lower than that in non-fulminant group.In fulminant group,the ventricular tachycardia had greater percentage,the PR interval was longer,and the QRS complex was wider than those in non-fulminant group（all P〈 0.05）.The proportions of first and third degree atrioventricular block and right bundle branch block were significantly higher in fulminant group than those in non-fulminant group（all P〈 0.05）. Conclusions：Prolonged PR interval,widened QRS complex,decreased QRS amplitude,first and third degree atrioventricular block,right bundle branch block,ventricular tachycardia,are important factors for early identification of fulminant myocarditis.