心电图N波对急性心肌梗死患者血管病变部位及心功能判断价值

The value of electrocardiogram N wave in judgment of vascular lesion and cardiac function in patients with acute myocardial infarction

目的探讨心电图N波对急性心肌梗死患者血管病变部位及心功能的判断价值。方法选取自2017年3月至2018年12月武汉大学中南医院心血管内科收治的经冠状动脉造影检查为左回旋支罪犯血管引起急性心肌梗死的198例患者为研究对象。根据心电图分为急性ST段抬高型心肌梗死(STEMI)组(n=74)、有N波急性非ST段抬高型心肌梗死(NSTEMI)组(n=51)及无N波NSTEMI组(n=73)。观察各组患者的临床相关资料、入院至手术时间、并发症发生率、血管病变部位及心功能相关指标。结果无N波NSTEMI组肌酸激酶同工酶、肌钙蛋白Ⅰ水平低于STEMI组与有N波NSTEMI组(P<0.05)。有N波NSTEMI组无复流发生率高于STEMI组与无N波NSTEMI组(P<0.05)。无N波NSTEMI组左回旋支病变部位在近段与中段发生率明显低于STEMI组与有N波NSTEMI组,而左回旋支病变部位在远段与钝缘支发生率较高,且平均血管狭窄程度低于STEMI组与有N波NSTEMI组,差异均有统计学意义(P<0.05)。有N波NSTEMI组射血分数、心排血量、每搏输出量明显低于STEMI组与无N波NSTEMI组(P<0.05)。结论心电图发生N波的NSTEMI梗死部位更容易在左回旋支近中段发生,且梗死面积较大,无复流发生风险较高,心功能指标均明显降低。

Objective To evaluate the value of electrocardiogram N wave on the location of vascular lesion and cardiac function in patients with acute myocardial infarction.Methods A retrospective study was performed on 198 cases of patients with acute myocardial infarction caused by left circumflex artery who were admitted from March 2017 to December 2018.According to the electrocardiogram,the patients were divided into the acute ST-segment elevation myocardial infarction(STEMI)group(n=74),the N wave NSTEMI group(n=51)and the N-free wave NSTEMI group(n=73).Clinical data,time from admission to surgery,incidence of complications,location of vascular lesions and cardiac function were observed in each group.Results N-free wave NSTEMI group of creatine kinase isoenzyme,Ⅰtroponin levels below STEMI and N wave NSTEMI group(P<0.05).The incidence of no reflow in the N-wave NSTEMI group was higher than that in the STEMI group and the N-free wave NSTEMI group(P<0.05).The incidence of the lesion of the left convoluted branch in the near segment and middle segment of the N-free wave NSTEMI group was significantly lower than that of the STEMI group and the N-free wave NSTEMI group,while the incidence of the lesion of the left convoluted branch in the far segment and the blunt margin branch was higher,and the mean degree of vascular stenosis was lower than that of the STEMI group and the N-wave NSTEMI group,and the difference was statistically significant(P<0.05).Ejection fraction,cardiac output and stroke output of the N-wave NSTEMI group were significantly lower than those of the STEMI group and the N-free wave NSTEMI group(P<0.05).Conclusion The NSTEMI infarction site where N-wave occurs in electrocardiogram is more likely to occur near the middle segment of the left gyrobranch,and the infarction area is larger,with a higher risk of no reflow,and the cardiac function indexes are significantly reduced.