CAJ | 학술논문

目的：分析并评价不典型急性心肌梗死（AMI）患者的临床表现及心电图特征，为AMI的临床诊断提供参考。方法回顾分析41例不典型 AMI患者的临床症状、心电图、心肌酶谱、治疗与转归。结果41例患者以消化道及呼吸道症状为主。其中9例未见明显的ST段变化，仅见病理Q波；10例仅见 ST-T 缺血变化或损伤型抬高，未见病理Q 波；4例延缓见梗死图形，全部为下壁AMI；3例为常规12导联无梗死图形，属于正后壁AMI；4例原梗死图形消失，V1与V2导联Q波消失，可见小r波。最终治愈率达95.12％（39/41），2例死于心力衰竭。结论应根据临床表现、心肌酶学指标变化，并结合心电图的动态改变对不典型AMI进行综合诊断，避免发生误诊。
목적：분석병평개불전형급성심기경사（AMI）환자적림상표현급심전도특정，위AMI적림상진단제공삼고。방법회고분석41례불전형 AMI환자적림상증상、심전도、심기매보、치료여전귀。결과41례환자이소화도급호흡도증상위주。기중9례미견명현적ST단변화，부견병리Q파；10례부견 ST-T 결혈변화혹손상형태고，미견병리Q 파；4례연완견경사도형，전부위하벽AMI；3례위상규12도련무경사도형，속우정후벽AMI；4례원경사도형소실，V1여V2도련Q파소실，가견소r파。최종치유솔체95.12％（39/41），2례사우심력쇠갈。결론응근거림상표현、심기매학지표변화，병결합심전도적동태개변대불전형AMI진행종합진단，피면발생오진。
Objective To analyze and evaluate the clinical manifestations and electrocardiographic characteristics of patients with atypical acute myocardial infarction (AMI), and to provide references for the clinical diagnosis of AMI. Methods Data of 41 patients with atypical AMI on clinical symptoms, electrocardiographic characteristics, myocardial enzymes, treatment and prognosis were analyze retrospectively. Results Digestive and respiratory tract symptoms were found in the majority of patients with atypical AMI. Among the 41 patients, electrocardiography showed pathological Q waves without ST segment changes in 9, ST-T ischemic changes or injury elevation without the presence of pathological Q waves in 10, delayed infarction graphics for inferior wall AMI in 4, no infarction graphics for posterior wall AMI from the 12-lead electrocardiogram in 3, and small r waves with the disappearance of infarction graphics and Q waves in leads V1 and V2 in 4. The final cure rate was 95.12% (39/41). Two patients died of heart failure. Conclusion The clinical diagnosis of AMI should be made based on clinical manifestations, myocardial enzyme changes and dynamic electrocardiogram changes to avoid misdiagnosis.