冠状动脉急性完全闭塞的不典型心电图分析

朱红涛; 邱林林; 李斌义; 丁晓军; 赵剑锋; 欧阳巍立; 龚军辉; 童芸梅; 刘学庆

doi:10.13201/j.issn.1001-1439.2017.09.014

冠状动脉急性完全闭塞的不典型心电图分析

- 1 丹阳市人民医院心内科(江苏丹阳, 212300);
- 2 丹阳市人民医院超声科
基金项目:
江苏省镇江市卫生科技重点专项项目 (No:SHW2015020)

详细信息

通讯作者: 刘学庆, E-mail:drylxq@163.com

中图分类号: R541.4

收稿日期: 2017-04-14

Analysis of atypical electrocardiogram of acute complete occlusion of coronary artery

- 1 Cardiology Department, the People's Hospital of Danyang, Danyang, 212300, China;
- 2 Ultra-sonography Department, the People's Hospital of Danyang

More Information

Corresponding author: LIU Xueqing, E-mail: drylxq@163.com

Received Date: 14 April 2017

摘要

摘要: 目的:探讨冠状动脉(冠脉)急性完全闭塞的急性冠脉综合征(ACS)患者入院心电图的不典型改变,以便尽快做出侵入性治疗策略。方法:回顾性分析2014-01-2017-02于我院导管室行急诊PCI的1支主要冠脉急性完全闭塞患者168例,根据入院时心电图是否有典型改变分为2组:典型改变组156例(符合急性ST段抬高型心肌梗死典型心电图改变)和非典型改变组12例(表现为心电图无改变或ST段压低/T波倒置、低平)。了解3支主要冠脉闭塞的发生率、典型心电图改变发生率,不典型心电图改变发生率及其分布情况,记录患者进入急诊室大门到冠脉球囊扩张的时间(D-TO-B)和出院时左室射血分数(LVEF)。结果:168例患者冠脉闭塞性病变部位中,首先位于左前降支88例,其次为右冠脉58例,冠脉左回旋支22例;其中非典型改变组分别为5例(5.7%)、3例(5.2%)、4例(18.2%)。典型改变组D-TO-B时间为(2.75±0.76) h,非典型改变组为(3.54±0.80) h。左前降支闭塞患者中,非典型改变组较典型改变组EF值明显降低。结论:非典型改变组D-To-B时间明显延长,前降支闭塞非典型改变组心功能明显降低,所以早期识别有助于尽早采取侵入性治疗策略。
- 急性冠脉综合征 /
- 冠状动脉急性闭塞 /
- 心电图
Abstract: Objective:To investigate the atypical changes of electrocardiogram in patients with acute coronary syndrome (ACS) caused by acute complete occlusion of the coronary artery, and so we can make an invasive treatment strategy as soon as possible.Method:A total of 168 patients with ACS in our hospital from January 2014 to February 2017 were selected.Coronary angiography showed one of the coronary arteries completely closed.Patients' information was recorded and analysed, including symptoms, the incidence of three major coronary artery occlusion, the incidence of typical electrocardiogram changes, the incidence of atypical electrocardiogram changes and their distribution, the time of patient from the hospital door to the coronary artery balloon expansion time (door to balloon, D-TO-B) and EF values at discharge.Result:Of the 168 occlusive coronary arteries, 88 cases were left anterior descending artery, 58 cases were right coronary artery, and 22 cases were left circumflex artery, with 5 (5.7%), 3 (5.2%) and 4 (18.2%) cases in the atypical electrocardiogram group, respectively.The D-TOB time was (2.75±0.76) h in the electrocardiogram typical group and (3.54±0.80) h in the electrocardiogram atypical change group.In patients with left anterior descending coronary artery, compared with the electrocardiogram typical group, the EF value was significantly lower in the electrocardiogram atypical group. Conclusion:The D-To-B time was significantly prolonged and the cardiac function in patients with left anterior descending coronary artery occlusion was significantly decreased in the electrocardiogram atypical group.Therefore, early identification could help to adopt the invasive treatment strategy as soon as possible.
- acute coronary syndrome /
- acute coronary occlusion /
- electrocardiogram

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参考文献(15)

[1]	中华医学会心血管病学分会, 中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志, 2015, 43 (5):380-393.
[2]	MARTIN T N, GROENNING B A, MURRAY H M, et al.ST-segment deviation analysis of the admission 12-lead electrocardiogram as an aid to early diagnosis of acute myocardial infarction with a cardiac magnetic resonance imaging gold standard[J].J Am Coll Cardiol, 2007, 50:1021-1028.
[3]	SCHMITT C, LEHMANN G, SCHMIEDER S, et al.Schomig A.Diagnosis of acute myocardial infarction in angiographically documented occluded infarct vessel:limitations of ST-segment elevation in standard and extended ECG leads[J].Chest, 2001, 120:1540-1546.
[4]	SCHWEITZER P.The electrocardiographic diagnosis of acute myocardial infarction in the thrombolytic era[J].Am Heart J, 1990, 119:642-654.
[5]	吴祥, 蔡思宇."巨R波形"ST段抬高的特性及其临床意义[J].中华心血管病杂志, 2004, 32 (8):762-764.
[6]	马云霞, 张春丽, 钱大慈.老年人巨R波形心电图综合征3例[J].实用心电学杂志, 2007, 16 (3):230-231.
[7]	SCLAROVSKY S, BIRNBAUM Y, SOLODKY A, et al.Isolated mid-anterior myocardial infarction:a special electrocardiographic sub-type of acute myocardial infarction consisting of ST-elevation in non-consecutive leads and two different morphologic types of STdepression[J].Int J Cardiol, 1994, 46:37-47.
[8]	IWASAKI K, KUSACHI S, KITA T, et al.Prediction of isolated first diagonal branch occlusion by 12-lead electrocardiography:ST segment shift in leads I and aVL[J].J Am Coll Cardiol, 1994, 23:1557-1561.
[9]	BIRNBAUM Y, HASDAI D, SCLAROVSKY S, et al.Acute myocardial infarction entailing ST-segment elevation in lead aVL:electrocardiographic differentiation among occlusion of the left anterior descending, first diagonal, and first obtuse marginal coronary arteries[J].Am Heart J, 1996, 131:38-42.
[10]	DE WINTER R J, VEROUDEN N J, WELLENS H J, et al.A new ECG sign of proximal LAD occlusion[J].N Engl J Med, 2008, 359:2071-2073.
[11]	ABBAS A E, BOURA J A, BREWINGTON S D, et al.Acute angiographic analysis of non-ST-segment elevation acute myocardial infarction[J].Am J Cardiol, 2004, 94:907-909.
[12]	STRIBLING W K, KONTOS M C, ABBATE A, et al.Clinical outcomes in patients with acute left circumflex/obtuse marginal occlusion presenting with myocardial infarction[J].J Interv Cardiol, 2011, 24:27-33.
[13]	NIU T, FU P, JIA C, et al.The delayed activation wave in non-ST-elevation myocardial infarction[J].Int J Cardiol, 2013, 162:107-111.
[14]	SHAH A, WAGNER G S, GREEN C L, et al.Electrocardiographic differentiation of the ST-segment depression of acute myocardial injury due to the left circumflex artery occlusion from that of myocardial ischemia of nonocclusive etiologies[J].Am J Cardiol, 1997, 80:512-513.
[15]	BRADY W J.Acute posterior wall myocardial infarction:electrocardiographic manifestations[J].Am J Emerg Med, 1998, 16:409-413.