以急性左心衰竭为首发表现的普遍ST段压低型心肌梗死20例临床分析

目的分析以急性左心衰竭为首发表现的普遍ST段压低型心肌梗死的临床特点，探讨其发生心力衰竭的特征和原因。方法综合分析20例以急性左心衰竭为首发表现的普遍ST段压低型心肌梗死20例患者的病史和临床特点，根据心电图、心肌酶的动态变化、Killip心功能分级和心脏彩超报告的心功能指标，探讨普遍ST段压低型心肌梗死发生急性左心衰竭的特征和原因。随访10人的预后，1年内3人死亡。结果20例中，15例为无痛性心肌梗死；5例心肌酶轻度升高；随访1年内死亡率30％，均为糖尿患者；心电图特点：AVR和（或）V1导联S—T段抬高，余导联S—T普遍压低〉0．1mV，尤其V3～V6S—T段压低更明显，或T波呈对称性深倒置；心脏彩超：LVEF（40±10）％，LVEF〈40％8例，LVEF〉40％12例；节段性室壁动度减弱或不协调。结论以急性左心衰竭为首发表现的普遍ST段压低型心肌梗死的临床特点为：（1）多合并有冠心病发病的主要致病因素；（2）以急性左心衰竭为首发表现的普遍ST段压低型心肌梗死大多数为无痛性心肌梗死；（3）心电图显示心肌缺血及损伤的面积广泛；（4）表现为心脏收缩、舒张功能显著减弱或不协调；（5）心力衰竭是其严重的并发症，也是其主要死亡原因之一。

To Acute Left Ventricuiar Failure as the First Performance of the Universal-type ST-segment Depression Myocardial Infarction Clinical Analysis of 20 Cases

Objective Analysis of acute left ventricular failure as the first performance of the universal - type ST - segment depression in the clinical features of myocardial infarction to explore the characteristics of its occurrence and causes of heart failure. Methods A comprehensive analysis of 20 cases with acute left ventricular failure as the first performance of the universal- type ST- segment depression in 20 cases of myocardial infarction and history of the patient＇s clinical features, according to ECG, dynamic changes of enzymes, Killip classification of cardiac function and cardiac color report indicators of cardiac function to explore the widespread ST - segment depression myocardial infarction with acute left heart failure occurred in the char- acteristics and causes. 10 follow -up prognosis, 1 year, 3 people were killed. Results 20 cases, theFor 15 cases of painless myocardial infarction; 5 cases of mildly elevated enzymes; follow - up of 1 year mortality 30% , all patients with diabetes; ECG characteristics ： AVR and （or） V1 ST - segment elevation, Generally more than ST - depression 〉 0. 1 mV, especially the V3 - V6S-T segment depression more obvious, or T -wave inversion was the symmetry of the deep; heart color： LVEF （40±10）%, LVEF 〈40% 8 cases, LVEF 〉 40% 12 cases; regional wall weakening or uncoordinated mobility. Conclusion The combined have more than one major coronary heart disease risk factor; 2 to acute left ventricular failure as the first performance of the universal - type ST - segment depression for cardiac death painless myocardial infarction ; 3 electrocardiogram showed myocardial ischemia and injury in the area of broad ; 4 performance for cardiac systolic and diastolic function significantly weakened or nonconforming; 5 of heart failure is a serious complication, but also one of the main causes of death.