45例非ST抬高性心肌梗死的心电图特点及首诊误诊分析

目的探讨非ST段抬高性心梗（NSTEMI）的心电图变化特点及首诊误诊原因。方法对比分析我院近10来误诊的45例NSTEMI和50例冠脉供血不足冠心病病人的心电图资料，并对两组病人的首诊误诊情况进行比较。结果两组病人首诊ECG均以ST、T缺血性改变为主要表现，与对照组相比，NSTEMI组病人同时出现ST、T改变、单纯ST段下移、单纯T波低平或倒置、ST—T正常以及心律失常的几率差异无统计学意义（均P〉0．05）；对照组ST段下移多≤0．1mV），NSTEMI组ST段下移多≥0．2mV），差异均有统计学意义（P〈0．05）；NSTEMI组病人出现误诊的比率明显高于对照组（P〈0．01），心内科专业医生的误诊率低于其他内科专业医生（P〈0．05），而对照组内误诊率的差异无统计学意义（P〉0．05）。结论NSTEMI的心电图有ST、T动态改变的特点，但表现常不典型，临床误诊率较高，应引起重视。

Analysis on the feature of ECG and the misdiagnosis reasons of the first diagnosis of 45 cases of non-ST elevation myocardial infarction

Objective To evaluate the variety characteristics of ECG and the misdiagnosis reason of the first diagnosis of NSTEMI. Methods The eontrastive analysis of ECF, data of 45 misdiagnosed patients with NSTEMI and 50 patients with CHD at my hospital in 10 years, and the informations of two sets of first misdiagnosed patients were analysed. Results They all had ST and T ischemic change of ECG at first diagnosis. There were no difference between two groups in ST-T ischemic change, merely ST descended, lowering of T-wave or inversion, normal ST-T and arrhythmie probability（ P 〉0.05）; There were more ST descended≤0. 1mv in eontros group, more ST descended≥0.2my in NSTEMI group（ P 〈 0.05）. The ratio of misdiagnosed in NSTEMI group was obviously higher than that in control group（ P 〈 0.01 ）. The misdiagnosis rate of doctors of cardio-vessel medicine was lower than that of doctors of other medicine in NSTEMI group（ P 〈 0.05）, but in control group miscliagnosis rate was quiet（ P 〉0.05）. Conclusion The ECG of NSTEMI has ST-T dynamicly changed, but appeared often not typically, the clinical misdiagnosis rate is higher, we have to pay more attention on it.