非ST段改变的急性心肌梗死临床分析

目的 探讨非ST段改变的急性心肌梗死患者冠状动脉病变情况，指导进一步治疗。方法 选取我院2013年12月~2018年12月因胸闷、胸痛不适入住苏州高新区人民医院、新疆自治区人民医院的患者76例，入院行心电图未见相关导联ST段改变，动态观察心电图及血清超敏肌钙蛋白T、肌酸激酶同工酶，多次复查未发现心电图有动态改变，但血清超敏肌钙蛋白、肌酸激酶同工酶数小时，甚至更长时间开始升高，急诊行冠状动脉造影术（CAG），观察有无冠状动脉急性闭塞或次全闭塞，同时观察病变冠脉血管的部位、内径。结果 纳入的76例心电图无ST段改变，但数小时后血清心肌标志物升高的胸闷、胸痛患者行冠状动脉造影术发现:冠状动脉急性闭塞或次全闭塞的患者占94.74%，比例较高，多见于钝缘支，占78.95%，且冠脉血管内径均＞1.5 mm。结论 除了ST段抬高和ST段压低的急性心肌梗死，非ST段改变的急性心肌梗死也常常出现在临床当中，对此类不典型的患者，早期识别很重要，及时有效的处理，预后良好。

Clinical Analysis of Acute Myocardial Infarction with Non-ST Segmental Changes

Abstract:Objective To investigate the coronary artery lesions in patients with acute myocardial infarction who have not changed ST-segment and to guide further treatment.Methods 76 patients with chest tightness and chest pain were admitted to the People's Hospital of Suzhou High-tech Zone and the People's Hospital of Xinjiang Autonomous Region in the past 5 years. The ST-segment of the relevant lead was not observed in the electrocardiogram of the hospital, and the electrocardiogram and serum hypersensitive troponin T were observed dynamically. Creatine kinase isoenzyme, no repeated examination of ECG has found dynamic changes in the electrocardiogram, but serum hypersensitive troponin, creatine kinase isoenzyme began to rise for several hours, even longer, emergency coronary angiography (CAG), to observe whether there is acute or partial occlusion of coronary artery, and to observe the location and inner diameter of the coronary vessels. Results The 76 patients with ECG had no ST-segment changes, but after a few hours, patients with chest tightness and chest pain who had elevated serum myocardial markers underwent coronary angiography. The patients with acute or secondary occlusion of coronary artery accounted for 94.74%, a higher proportion. It is more common in the blunt edge, accounting for 78.95%, and the diameter of the coronary vessels is >1.5 mm. Conclusion In addition to acute myocardial infarction with ST-segment elevation and ST-segment depression, acute myocardial infarction with non-ST-segment changes often occurs in the clinic. For such atypical patients, early recognition is important, timely and effective treatment, and good prognosis.