53例心脏挫伤的心电图改变

目的观察心脏钝性挫伤的心电图表现及其临床意义。方法53例心脏钝性挫伤患者（11例伴心力衰竭，42例心功能正常，47例患单纯心脏损伤，6例并发瓣膜和／或房室间隔损伤）接受连续床边心电监护，并检查血清肌酸磷酸激酶同工酶（CK—MB）。结果53例患者中发现心电图异常者43例（81．13％），包括ST—T段上升（27例，29．03％，主要发生于前、侧壁导连），ST段下降（14例，15．03％），束支传导阻滞（11例），T波改变（10例）、新出现的异常Q波（5例，5．37％），以及房室传导阻滞（5例，5．37％）。心力衰竭组的心电图改变率为100％，显著高于心功能正常组（73．86％，P〈0．05）。心脏损伤并发瓣膜和／或房室间隔损伤患者的严重心电图改变率为66．7％，显著高于单纯心脏损伤组（21．2％，P〈0．01）。心电罔正常者的病死率为0，显著低于心电图异常者（18．60％，P〈0．05）。ST段上升高出基线0．1mV以上耆和出现异常Q波者的血清CK—MB值为正常的3倍以上。结论心电图改变，特别是卯段上升和异常Q波，可用以帮助早期诊断心肌挫伤和预测其预后。

Electrocardiographic changes in cardiac contusion: analysis of 53 cases

Objective To investigate the manifestations and significance of electrocardiographic changes in cardiac contusion. Methods Fifty-three patients with cardiac contusion, 11 with heart failure and 42 with normal cardiac function, 47 with pure cardiac damage and 6 with cardiac damage complicated with damage of valve and/or septum, underwent bedside monitoring of elelctrocardiogram （ECG） and examination of serum creatine phosphate kinase-MB （CK-MB）. Results Abnormal ECG changes were found in 43 cases （81.13%）, including ST-segment elevation （27 cases, 29.03%, mainly in the anterior and lateral wall leads）, ST-segment depression （14 cases, 15.03%）, bundle-branch block （11 cases）, T wave changes （10 cases）, newly emerging abnormal Q wave （5 cases, 5.37%）, and auriculo-ventricular block （5 cases, 5.37%）. The ECG change percentage of the heart failure group was 100%, significantly higher than that of the normal cardiac function group （73.86%, P 〈0.05）. The severe ECG change rate of the patients with cardiac damage combined with damage of valve and/or septum was 66.7%, significantly higher than that of the patients with pure cardiac damage （21.2%, P 〈0.01）. The mortality of the patients with normal ECG was 0, significantly lower than that of the patients with abnormal ECG （18.60%, P 〈0.05）. The levels of serum CK-MB of the patients with the ST-segment elevation more than 0.1 mV over the baseline and the patients with newly-emerging Q wave were as high as 3 times of the normal level. Conclusion ECG changes, especially ST-segment elevation and abnormal Q wave can be used to diagnose of cardiac contusion and predict the prognosis thereof.