CAJ | 학술논문

目的：观察不同心电图ST段偏移表现的非ST段抬高型心肌梗死（ NSTEMI）患者临床特征，探讨依据心电图对其进行分类的临床意义。方法：早期行冠状动脉造影检查的NSTEMI患者203例，依据心电图ST段偏移方式的不同分为：ST段压低型心肌梗死组（压低组，121例）和ST段无偏移型心肌梗死组（无偏移组，82例）。分析患者的临床特征、冠状动脉病变特点、梗死相关动脉（ IRA）及其介入治疗前后TIMI血流分级、患者病死率。结果：①无偏移组患者年轻、男性多见，心肌梗死及糖尿病病史较少见。②无偏移组中单支血管病变者明显多于压低组（χ2＝14．868，P＝0．002），且IRA以回旋支多见；IRA TIMI 0、1级的比率低于压低组（χ2＝37．516，P＜0．001）。无偏移组患者IRA侧支循环TIMI 2、3级的比率高于压低组患者（χ2＝12．500，P＜0．001）。③无偏移组中行急诊介入治疗的患者少于压低组（χ2＝18．160，P＜0．001）。2组患者病死率差异无统计学意义（χ2＝1．810，P＝0．178）。结论：NSTEMI患者临床表现较轻，但也要选择早期冠状动脉造影检查，并积极行介入治疗。
목적：관찰불동심전도ST단편이표현적비ST단태고형심기경사（ NSTEMI）환자림상특정，탐토의거심전도대기진행분류적림상의의。방법：조기행관상동맥조영검사적NSTEMI환자203례，의거심전도ST단편이방식적불동분위：ST단압저형심기경사조（압저조，121례）화ST단무편이형심기경사조（무편이조，82례）。분석환자적림상특정、관상동맥병변특점、경사상관동맥（ IRA）급기개입치료전후TIMI혈류분급、환자병사솔。결과：①무편이조환자년경、남성다견，심기경사급당뇨병병사교소견。②무편이조중단지혈관병변자명현다우압저조（χ2＝14．868，P＝0．002），차IRA이회선지다견；IRA TIMI 0、1급적비솔저우압저조（χ2＝37．516，P＜0．001）。무편이조환자IRA측지순배TIMI 2、3급적비솔고우압저조환자（χ2＝12．500，P＜0．001）。③무편이조중행급진개입치료적환자소우압저조（χ2＝18．160，P＜0．001）。2조환자병사솔차이무통계학의의（χ2＝1．810，P＝0．178）。결론：NSTEMI환자림상표현교경，단야요선택조기관상동맥조영검사，병적겁행개입치료。
Aim:To explore the clinical features in patients with non-ST-elevation myocardial infarction ( NSTEMI) and different electrocardiographic manifestations .Methods:A total of 203 consecutive patients with NSTEMI undergone early coronary angiography .According to the difference of ST segment deviation pattern ,the patients were divided into two groups:ST-depression group(121 cases)and non-ST-deviation group(82 cases).The clinical characteristics,the lesion features of coronary artery,the mortality in hospital,infarction related artery(IRA)and its TIMI grades prior and after interventional therapy were analyzed.Results:(1)The young and male patients were less common for myocardial infarction and diabetes in non-ST-deviation group.(2)There were more single-vessel lesion in non-ST-deviation group(χ2 =14.868,P=0.002), and the IRA was often the circumflex artery .The rate of total occlusion of IRA in non-ST-deviation group was lower than that in ST-depression group(χ2 =37.516,P<0.001).Collateral circulation in non-ST-deviation group was better than that in ST-depression group(χ2 =12.500,P<0.001).(3)It was more frequent in ST-depression group without primary percutane-ous coronary intervention than non-ST-deviation group(χ2 =18.160,P<0.001).The rates of death between the two groups had no significant differences (χ2 =1.810,P=0.178).Conclusion:There are obvious differences between ST-depression and non-ST-deviation groups in clinical characteristics ,the lesion features of coronary artery ,therapy strategy and the mortal-ity in hospital .NSTEMI patients with different ECG manifestations should be treated with PCI in time .