诊断不典型心肌梗死中心电图的价值研究

The Value of Ecg in Diagnosis of Atypical Myocardial Infarction

目的探讨不典型心肌梗死中心电图的诊断价值。方法在该医院2016年11月—2017年12月期间诊治的不典型心肌梗死患者中方便选取51例作研究组,同期方便选取典型心肌梗死患者51例作对照组。对两组患者进行心电图检查,并比较两组首发症状、心电图特征、心肌酶谱检查结果与诊断准确率差异进行统计学分析。结果①研究组患者中无痛者、不典型疼痛者比率均高于对照组(χ^2=7.516、55.636,P=0.006、0.000),而典型上腹部疼痛+胸背部疼痛者比率低于对照组(χ^2=74.339,P=0.000);②研究组中无ST-T段改变、无病理性Q波+T波直立+ST段抬高患者所占比率高于对照组(χ^2=12.330、8.681,P=0.000、0.003);,而病理性Q波+T波倒置+ST段弓背抬高者所占比率低于对照组(χ^2=24.878,P=0.000);③研究组患者的3项心肌酶谱指标肌酸激酶、同工酶、血清心肌肌钙蛋白I水平均低于对照组(t=11.054,44.299,19.945,P<0.05);④心电图联合心肌酶谱检查方案对研究组、对照组患者的诊断准确率均高达100.00%,比较差异无统计学意义(χ^2=0.000,P=1.000);心电图对研究组的诊断准确率88.24%低于对照组的100.00%(χ^2=4.427,P=0.035)。结论心电图用于心肌梗死临床诊断中的价值显著,但对于不典型心肌梗死患者,应联合心肌酶谱诊断,以提高诊断准确性。

Objective To investigate the diagnostic value of electrocardiogram in atypical myocardial infarction.Methods 51 patients with atypical myocardial infarction treated in the hospital from November 2016 to December 2017 were convenient selected as the study group,and 51 patients with typical myocardial infarction were selected as the control group during the same period.The two groups of patients were examined by ecg,and the differences in the first symptoms,electrocardiogram characteristics,myocardial enzyme spectrum and diagnostic accuracy between the two groups were statistically analyzed.Results 1.the ratio of painless patients and atypical pain in the study group was higher than that in the control group(χ^2=7.516,55.636,P=0.006,0.000),while the ratio of typical upper abdominal pain+chest and chest pain was lower than that of the control group(χ^2=74.339,P=0.000);2.the proportion of patients without ST-T segment changes,no pathological Q wave+T wave erect+ST segment elevation in the study group was higher than that of the control group(χ^2=12.330,8.681,P=0.000,0.003);and the proportion of pathological Q wave+T wave inversion+ST segmental arch height elevation was lower than that of the control group(χ^2=24.878,P=0.000);3.three myocardial zymograms of the study group patients The levels of creatine kinase,isoenzyme and serum cardiac troponin I were lower than those of the control group(t=11.054,44.299,19.945,P<0.05);4.electrocardiogram combined with myocardial zymography protocol for the study group.The diagnostic accuracy of the control group was as high as 100.00%,and the difference was not statistically significant(χ^2=0.000,P=1.000).The diagnostic accuracy of the electrocardiogram for the study group was 88.24%lower than that of the control group 100.00%(χ^2=4.427,P=0.035).Conclusion electrocardiogram(ecg)has significant value in clinical diagnosis of myocardial infarction.