冠脉旁路移植术后心电图改变的临床评价

目的 探讨冠脉旁路移植术(coronary artery bypass grafting，CABG)后各种缺血性心电图改变的临床意义，评价其围术期心梗和心肌缺血的早期诊断价值及与术后早期预后的相关性。方法 108例患者于CABG术后2—10d进行2次／d的12标准导联心电图检查，术后第7天、第14天常规12导联心电图检查1次。依据急性心梗及心肌缺血的心电图诊断标准记录阳性改变。根据有无心电图阳性改变将本组患者分为研究组和对照组，进行手术前后超声心动图EF值及室壁运动情况、术后心肌酶、血流动力学情况和相关并发症等的比较及统计学分析。结果 单纯ST-T改变者51例(研究组1)，出现Q波者15例(研究组2)，无阳性改变者42例(对照组)，各研究组与对照组在以上观察指标的比较中无显著差别。结论 CABG术后心电图的缺血性改变并非围术期心梗和心肌缺血的特异性诊断指标及术后早期顸后的判断指标。

Clinical evaluation of ECG alteration after CABG

ObjectiveTo inquire into the clinical importance of ischemic electrocardiogram (ECG) alternations after coronary artery bypass grafting (CABG) and evaluate its early diagnostic value and relativity to postoperative early outcome.MethodsOne hundred and eight patients,who underwent CABG,were included in this respective study.All the patients performed ECG two times per day in two to ten days after CABG.According to the diagnosis standard of acute myocardial infarction (AMI) and acute myocardial ischemia,positive alterations were recorded.Meantime EF value,regional wall motion abnormalities,myocardial enzyme value increases,hemodynamic abnormalities and relative complications were recorded and compared statistically between the patients with positive ECG alterations (study group)and those without these alterations (control group).ResultsFifty-one patients (study group 1)presented ST-T positive alterations,fifteen patients (study group 2)presented new Q wave.Forty-two patients(control group) were free from positive alterations.There was no significant difference between two groups compared by these parameters.ConclusionIschemic ECG alterations can be used neither as an independent diagnostic index for PMI and acute myocardial ischemia nor as a powerful tool for predicting short-term cardiac outcome.