急性左心衰竭为首发表现的急性心内膜下心肌梗死20例临床分析

目的：分析以急性左心衰竭为首发表现的急性心内膜下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急性心内膜下心肌梗死20例患者的病史和临床特点，粳据心电图、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，探讨急性心内膜下心飘梗死发生急性左心衰竭的特征和原因。随访10例患者1年．3例死亡。结果：20例患者中，15例为无痛性心肌粳死．5例心肌瓣轻度升高，随访1年内死亡率为30％，均为糖尿患者；心电图特点：AVR和（或）V1导联S—T段抬高，其余导联普遍性S—T段压低〉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〉140％12例，节段性室壁动度减弱或不协调。结论：①患者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急性心内膜下心肌梗死多为无痛性心肌梗死；③心电图显示心肌缺血及损伤的面积广泛；④心脏彩超表现为心脏收缩、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，也是主要死亡琢因之一。

Clinical analysis on acute left Ventricular failure as the first manifestations of acute subendocardial myocardial inflarction of 20 cases

Objective：Analyzed of acute left ventricular failure as the first manifestations of acute subendocardial myocardial infarction clinical features, 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 manifestations of acute subendocardial myocardial infarction patients with a history of 20 cases and clinical characteristics, according to ECG,dynamic changes of enzymes,Killip classification of cardiac function and cardiac color report indicators of cardiac function,acute subendocardial myocardial infarction with acute left heart failure occurred in the characteristics and causes.Ten patients were followed up, 1 year,three people died.Results：Among 20 cases, 15 cases of painless myocardial infarction;5 cases of normal or mildly elevated enzymes;the mortality rate was 30% in one year,mostly among diabetic patients;ECG char acteristics： AVR and （or） V1 ST-segment elevation,more than the universality of lead ST-segment depression〉0.1 my, especially the V3-V6 S-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 case, regional wall weakening or uncoordinated mobility. Conclusion： （1）The patient usually combined have more than one major coronary heart disease risk factor;, （2）Acute left yen tricular failure as the first manifestations of acute subendocardial myocardial infarction for painless myocardial infarction; （3）Electrocardiogram showed myocardial ischemia and the site of injury and a broad area; （4）Performance for cardiac systolic and diastlic function significantly weakened or non-conforming; （5）Heart failure is a serious complication,but also one of the main causes of death.