急性ST段抬高型心肌梗死心电图表现特征及临床价值

Characteristics and Clinical Value of Electrocardiogram in Acute ST-segment Elevation Myocardial Infarction

目的探析急性ST段抬高型心肌梗死心电图表现特征及临床价值。方法选取2018年3月—2021年3月在滨州医学院附属医院心电图室接受治疗的80例患者为观察对象,根据心电图表现将其划分为两组,将心电图表现为非QRS终末扭曲的40例急性ST段抬高型心肌梗死患者视为对照组,将心电图表现为QRS终末扭曲的40例急性ST段抬高型心肌梗死患者视为观察组。分析两组一般资料;合并缺血性J波、未合并缺血性J波患者室性心律失常发生率、病死率以及心电监测准确率。结果两组在性别、年龄、病程、入院时间、居住地、梗死部位方面对比,差异无统计学意义(P>0.05),观察组的CK高值、CK-MB值明显高于对照组,差异有统计学意义(t=5.537、7.857,P<0.05)。合并缺血性J波心肌梗死28例,占35.00%;未合并缺血性J波心肌梗死患者52例,占65.00%;其中合并缺血性J波心肌梗死中室性心律失常的发生率(64.29%)明显高于未合并缺血性J波心肌梗死患者(40.38%),差异有统计学意义(χ^(2)=4.161,P<0.05);观察组的病死率(7.50%)低于对照组(30.00%),差异有统计学意义(P<0.05)。梗死血管经冠状动脉造影和心电监测结果一致者为74例,准确率为92.50%(74/80),误判2例,误判率2.50%(2/80),无法判断的4例,发生率为5.00%(4/80)。结论急性ST段抬高型心肌梗死心患者采用心电图监测可以明确地判断梗死部位,可以为后期的治疗提供可靠依据。相比非QRS终末扭曲急性ST段抬高型心肌梗死,QRS终末扭曲急性ST段抬高型心肌梗死病情严重,预后效果不理想,采用心电图可以对梗死血管进行预判,可以在一定程度上降低误差,对降低病死率具有重要的意义,但对无法判断的情况还需引起重视,尽可能提高心电图的应用价值。

Objective To analyze the electrocardiogram characteristics and clinical value of acute ST-segment elevation myocardial infarction.Methods 80 patients who were treated in the ECG room of the Affiliated Hospital of Binzhou Medical College from March 2018 to March 2021 were selected as observation objects.They were divided into two groups according to their electrocardiogram performance,and 40 patients with acute ST-segment elevation myocardial infarction whose electrocardiogram showed non-QRS terminal distortion were regarded as the control group.40 patients with acute ST-segment elevation myocardial infarction whose ECG showed terminal distortion of QRS were regarded as the observation group.Analyzed the general data of the two groups,the incidence of ventricular arrhythmia,the mortality rate and the accuracy of ECG monitoring in patients with ischemic J wave and without ischemic J wave.Results There was no statistically significant difference between the two groups in terms of gender,age,course of disease,hospitalization time,place of residence,and infarct location(P>0.05).The high CK value and CK-MB value of the observation group were significantly higher than those of the control group,the difference was statistically significant(t=5.537,7.857,P<0.05).There were 28 cases with ischemic J wave myocardial infarction,accounting for 35.00%.There were 52 patients without ischemic J wave myocardial infarction,accounting for 65.00%.Among them,the incidence of ventricular arrhythmia in patients with ischemic J-wave myocardial infarction was 64.29%was significantly higher than 40.38%in patients without ischemic J-wave myocardial infarction,the difference was statistically significant(χ^(2)=4.161,P<0.05).The case fatality rate of the observation group was 7.50%lower than that of the control group 30.0%,the difference was statistically significant(P<0.05).The results of coronary angiography and ECG monitoring of infarcted vessels were consistent in 74 cases,the accuracy rate was 92.50%(74/80),2 cases were misjhdged,the misjudgment rate was 2.50%(2/80),and 4 cases that could not be judged,the incidence rate was 5.00%(4/80).Conclusion The use of ECG monitoring in patients with acute ST-segment elevation myocardial infarction can clearly determine the location of the infarction,which can provide a reliable basis for later treatment.Compared with non-QRS terminal twisted acute ST-segment elevation myocardial infarction,QRS terminal twisted acute ST-segment elevation myocardial infarction is more serious and the prognosis effect is not ideal.Electrocardiogram can be used to predict the infarcted blood vessel.To a certain extent,the error can be reduced,which is of great significance for reducing the mortality rate.However,attention should be paid to situations that cannot be judged,and the application value of ECG should be improved as much as possible.