急性前壁心肌梗死墓碑型心电图改变临床探讨

目的探讨急性前壁心肌梗死（AMl）与墓碑型心电图改变的关系及临床意义.方法对64例前壁AMI病例进行回顾性分析.墓碑组12例,非墓碑组52例,对比分析两组临床特征、冠脉造影表现和血管重建方法.结果墓碑组肌酸激酶-MB峰值、住院并发症（死亡、泵衰竭、心源性休克和心室颤动）、经血运重建治疗（溶栓和经皮冠脉介入治疗）明显高于非墓碑组（p＜0.05）,LVEF明显降低（p＜0.01）,而心绞痛、心率、血压、血脂、血糖、急性肺水肿、室性心动过速、传导阻滞、住院总天数两组间差异无显著性意义（p＞0.05）.结论虽然对前壁AMI患者墓碑型心电图改变者已做到早期识别危险分层与积极干预治疗,但预后仍不良,提示墓碑型心电图改变的机制可能与侧支循环建立不良及内皮损伤有关.

Clinical Explore in Patients With the "Tombstoning" Eletrocardiographic Pattern and Anterior Wall Acute Myocardial Infarction

Objective To explore the correlation between clinical manifestation and the"tombstoning" electrocardiographic pattern in patients with anterior wall acute myocardial infarction (AM1). Methods 64 patients with anterior wall acute myocardial infarction were divided into 2 groups. There were 12 patients in tombstoning ECG group and 52 patients in non-tombstoning group. Clinical characteristics,coronary angiography findings and revascularization were compared in 2 groups. Result Tombstoning group had a higher prevalence of peak creatine kinase-MB, in-hospital complications (death,pump failure,cardiogenic shock and ventricular fibrillation) and revascularization (thrombolysis and percutaneous coronary intervention) than non-tombstoning group(P<0.05). Left ventricular ejection fraction was lower than those of non-tombstoning group(P<0.01). There was a similar prevalence of preinfarction angina,heart rate,blood pressure,plasma lipid level,glucose,acute pulmonary edema,ventricular tachycardia,conduction block,stay in hospital in tombstoning group versus non-tombstoning group(p>0.05). Conclusion Although the patients with tombstoning ECG pattern were identified early and were treated actively,but they still had bad prognoses. It suggests that tombstoning changes are possibly associated with the badness of collateral vessels and the injury of endothelium.