墓碑形ST段抬高对心肌梗死范围及近期预后的影响

目的　探讨心电图墓碑形 ST段抬高对心肌梗死范围及预后的影响。方法　根据心电图 ST段抬高形式 ,将170例急性 ST段抬高型心肌梗死患者分为墓碑形组 5 2例 ,非墓碑形组 118例 ,比较两组心电图 ST段抬高振幅、QRS记分、血清肌酸激酶 (CK )及其同工酶 (CK - MB)峰值 ,并对其 4周内心脏事件进行分析。结果　墓碑形组 ST段抬高的振幅、QRS记分、CK和 CK- MB峰值均显著高于非墓碑形组 (P<0 .0 1)。墓碑形组心源性休克、心力衰竭、心室颤动和病死率分别为 11.5 4 %、4 2 .31%、2 6 .92 %和 19.2 3%,均高于非墓碑形组 2 .5 4 %、2 4 .5 8%、12 .71%和6 .78%(P<0 .0 5 )。 L ogistic回归分析结果显示 ,墓碑形 ST段抬高与心源性休克、心力衰竭、心室颤动和死亡危险独立相关 (OR分别为 1.880、1.5 73、2 .2 75和 3.0 6 4 ;均 P<0 .0 5 )。结论　墓碑形 ST段抬高提示心肌梗死范围大 ,是预后不良的独立预测指标。

Influence of tombstoning of ST segment elevation on infarct size and short term prognosis of patients with acute myocardial infarction

Objective To explore the influence of tombstoning of ST segment elevation in EKG on infarct size and short term prognosis of patients with acute myocardial infarction(AMI). Methods 170AMI patients were divided into tombstoning group(n=52) and non- tombstoning group(n=118) according to the shape of ST segment.The infarct size was determined by ST segment elevation amplitudes, QRS scoring system, serum peak value of CK and CK-MB.The cardiac events during 4 weeks were also analyzed. Results ST segment elevation amplitudes, QRS score, the peak value of CK and CK-MB in tombstoning group were significantly higher than corresponding measures in non- tombstoning group(P<0.01).Rates of cardiogenic shock, heart failure, ventricular fibrillation and mortality in tombstoning group were markedly increased as compared with non- tombstoning group(11.54% vs 2.54%; 42.31% vs 24.58%; 26.92% vs 12.71%; 19.23% vs 6.78%,respectively, P<0.05). Multivariate logistic regression analysis demonstrated that tombstoning of ST segment elevation was independently and obviously related to occurrence of cardiogenic shock (OR=1.880,P=0.032),heart failure(OR=1.573,P=0.012), ventricular fibrillation(OR=2.275,P=0.045) and cardiac death(OR=3.064,P=0.024). Conclusion Tombstoning of ST segment elevation in EKG is an independent predictor of poor prognosis in AMI patient, reflecting large-size infarct.