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目的研究急性前壁心肌梗死(AAMI)患者急性期心电图ST段抬高形态与近期预后的关系。方法根据入院时心电图V3导联ST段抬高的不同形态将62例首次住院的AAMI患者分为3组:A组(ST段呈弓背向下抬高)18例,B组(ST段呈斜坡状抬高)27例,C组(ST段呈弓背向上抬高)17例。测定3组患者血清磷酸肌酸激酶(CPK)峰值、左室射血分数(LEVF),记录住院4周内严重并发症(包括恶性心律失常、左心功能不全和心源性休克)的发生率以及住院4周内的死亡率。结果3组患者血清CPK峰均值分别为2014.4、4486.8和5826.9IU/L,A组CPK峰均值显著低于B组和C组(P<0.05和P<0.01),B组CPK峰均值显著低于C组(P<0.05);而3组患者LEVF分别为62.1%、48.6%和38.7%,A组LEVF显著高于B组和C组(P<0.05和P<0.01),B组LEVF显著高于C组(P<0.05)。A组住院4周内严重并发症发生率和4周内死亡率明显低于B组和C组(P<0.05),而B组和C组比较,无显著性差异(P>0.05)。结论AAMI早期V3导联ST段抬高的不同形态可以反映心肌缺血性损伤的严重程度,入院时心电图V3导联ST段呈弓背向上抬高对AAMI患者的近期预后可产生不良影响。
Objective To investigate the relationship between ST segment elevation in ECG and prognosis in patients with acute anterior myocardial infarction (AAMI). Methods Sixty-two first-time hospitalized patients with AAMI were divided into three groups according to different forms of ST-segment elevation of electrocardiogram V3 lead: 18 patients in group A (ST segment was dorsoventral elevation), B group Elevation in 27 cases, C group (ST segment was raised upward bow) 17 cases. Serum creatine phosphokinase (CPK) peak and left ventricular ejection fraction (LEVF) were measured in 3 groups. The incidence of serious complications (including malignant arrhythmia, left ventricular dysfunction and cardiogenic shock) within 4 weeks of admission were recorded And 4-week hospital mortality. Results The mean CPK peak values of the three groups were respectively 2014.4, 4486.8 and 5826.9 IU / L, the mean peak CPK of group A was significantly lower than that of group B and C (P <0.05 and P <0.01) LEVF in group A was significantly higher than that in group B and C (P <0.05 and P <0.01), while LEVF in group B was significantly higher than that in group C (P <0.05); LEVF was 62.1%, 48.6% and 38.7% In group C (P <0.05). The incidence of serious complications and the 4-week mortality in hospitalized patients in group A were significantly lower than those in group B and C (P <0.05). There was no significant difference between group B and C (P> 0.05). Conclusions Different forms of ST segment elevation of V3 lead in early AAMI can reflect the severity of myocardial ischemic injury. ST-segment elevation of V3 lead on admission leads to adverse effect on the short-term prognosis of AAMI patients.