实用老年医学 ›› 2010, Vol. 24 ›› Issue (2): 147-149.

• 论著 • 上一篇    下一篇

老年急性心肌梗死墓碑形ST段抬高的临床意义

  

  1. 广西医科大学第三附属医院心电诊断科
  • 出版日期:2010-04-20 发布日期:2010-03-10

Clinical significance of tombstoning of ST segment in elderly patients with acute myocardial infarction

  • Online:2010-04-20 Published:2010-03-10

摘要:

目的探讨老年人急性心肌梗死(acute myocardial infarction,AMI)墓碑形ST段抬高的临床意义。方法收治AMI患者468例,依据心电图ST段抬高特征,其中有墓碑形42例,根据年龄分墓碑形老年组30例,墓碑形非老年组12例,另随机选择其他形态ST段抬高50例为对照组进行多项指标分析。结果墓碑形老年组100%合并有基础疾病,经皮冠脉介入治疗(PCI)前心梗后心绞痛、并发症及死亡的发生率、心电图ST段抬高及出现病理性Q波的导联数、振幅明显高于墓碑形非老年组;而墓碑形组的以上各项临床及心电图指标亦明显高于其他形态组;且PCI后心肌缺血再灌注损伤的发生率亦是墓碑形老年组明显高于非老年组。结论墓碑形ST段抬高是AMI近期预后险恶的独立指标,尤以老年墓碑形ST段抬高者为甚,提示对此类患者应高度重视并积极预防心肌缺血再灌注损伤的发生。

关键词: 急性心肌梗死, 墓碑形ST段, 心肌缺血再灌注, 老年人

Abstract:

ObjectiveTo investigate clinical significance of tombstoning of ST segment in acute myocardial infarction (AMI) in the elderly.MethodsAmong 468 patients with AMI, there were 42 cases whose ECG showed tombstoning of ST segment. According to the patients’age, those 42 cases were divided into elder tombstoning of ST segment group and nonelder tombstoning of ST segment group. Besides, 50 cases whose ECG showed ST segment elevation in other shapes were chosen randomly as control group in the 468 patients. Some indexes were analyzed in these three groups.Results100% of the elderly patients with tombstoning ST segment elevation were found to have underlying diseases.The incidence rate of postmyocardial infarction angina before PCI,complication, mortality, leads of ST segment elevation  or  pathologic Q wave, amplitude were all significantly higher than those of the nonelder patient groups. And all the above values in tombstoning group were higher than those in other groups,and the difference was statistically significant. And the incidence rate of ischemic myocardial reperfusion after PCI is significantly higher in tombstoning group than that in nonelder patient groups.ConclusionsThe tombstoning of ST segment suggests the poor prognosis in AMI patients, especially in elderly patients. These patients should be cautioned against reperfusion injury.

Key words: acute myocardial infarction, tombstoning of ST segment, myocardial ischemia reperfusion injury, aged

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