心电图以ST段抬高为特征的老年急性心肌炎临床特点分析
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摘要
目的分析心电图以ST段抬高为特征的老年急性心肌炎临床特点。方法回顾性分析2010年2月—2016年3月来我院就诊的62例老年急性心肌炎患者。根据心电图表现分为ST段抬高组34例,非ST段抬高组28例,比较2组患者的一般情况、临床表现、实验室检查、超声心动图、冠状动脉造影、治疗资料及不良事件等。结果与非ST段抬高组相比,ST段抬高组急性心肌炎老年患者入院时心率较快,入院时收缩压和舒张压较低,差异均有统计学意义(P <0. 05); ST段抬高组中急性暴发性心肌炎患者21例(61. 76%),非ST段抬高组9例(32. 14%),差异有统计学意义(P <0. 05); ST段抬高组白细胞计数、肌酸激酶(CK)峰值、肌酸激酶同工酶(CKMB)峰值和肌钙蛋白Ⅰ(TnⅠ)峰值较非ST段抬高组高,差异有统计学意义(均P <0. 05); 2组患者住院期间均有发生不良事件,其中ST段抬高组心源性休克(26. 47%)、室颤(14. 71%)、住院期间病死率(20. 59%)均高于非ST段抬高组。结论 ST段抬高组老年急性心肌炎患者起病急、病情重,危险程度较非ST段抬高组老年急性心肌炎患者高,应及时正确判断并积极治疗,合理应用机械辅助治疗,减少不良事件的发生。
Objective To analyze the clinical characteristics of ST segment elevation in elderly patients with acute myocarditis. Methods A retrospective analysis was conducted in 62 patients with acute myocarditis from February 2010 to March 2016 in our hospital. According to electrocardiogram,34 cases were divided into ST-segment elevation group and28 cases in non-ST segment elevation group. The general situation,clinical manifestation,laboratory examination,echocardiography,coronary angiography,treatment data and adverse events were compared between the two groups. Results Compared with non-ST segment elevation group,the heart rate of ST segment elevation group was higher,and the systolic blood pressure and the diastolic blood pressure of ST segment elevation group were lower( P < 0. 05). There were 21 patients with acute fulminant myocarditis in the ST segment elevation group and 9 in the non-ST segment elevation group,the difference was statistically significant( P < 0. 05). ST segment elevation group of white blood cell count,peak creatine kinase( CK),creatine kinase isoenzyme MB( CKMB) peak and troponin I( Tn Ⅰ) peak is higher than non-ST segment elevation group,the difference was statistically significant( P < 0. 05). Adverse reactions occurred during hospitalization in both groups,among which cardiogenic shock( 26. 47%),ventricular fibrillation( 14. 71%) and inpatient mortality( 20. 59%) in the ST elevation group were higher than those in the non-ST elevation group. Conclusion ST-segment elevation in elderly patients with acute myocarditis acute onset and severe has higher risk than non-ST segment elevation elderly patients with acute myocarditis,should be timely and correctly treatment,the rational application of mechanical adjuvant therapy,can reduce the incidence of adverse reactions.
Objective To analyze the clinical characteristics of ST segment elevation in elderly patients with acute myocarditis. Methods A retrospective analysis was conducted in 62 patients with acute myocarditis from February 2010 to March 2016 in our hospital. According to electrocardiogram,34 cases were divided into ST-segment elevation group and28 cases in non-ST segment elevation group. The general situation,clinical manifestation,laboratory examination,echocardiography,coronary angiography,treatment data and adverse events were compared between the two groups. Results Compared with non-ST segment elevation group,the heart rate of ST segment elevation group was higher,and the systolic blood pressure and the diastolic blood pressure of ST segment elevation group were lower( P < 0. 05). There were 21 patients with acute fulminant myocarditis in the ST segment elevation group and 9 in the non-ST segment elevation group,the difference was statistically significant( P < 0. 05). ST segment elevation group of white blood cell count,peak creatine kinase( CK),creatine kinase isoenzyme MB( CKMB) peak and troponin I( Tn Ⅰ) peak is higher than non-ST segment elevation group,the difference was statistically significant( P < 0. 05). Adverse reactions occurred during hospitalization in both groups,among which cardiogenic shock( 26. 47%),ventricular fibrillation( 14. 71%) and inpatient mortality( 20. 59%) in the ST elevation group were higher than those in the non-ST elevation group. Conclusion ST-segment elevation in elderly patients with acute myocarditis acute onset and severe has higher risk than non-ST segment elevation elderly patients with acute myocarditis,should be timely and correctly treatment,the rational application of mechanical adjuvant therapy,can reduce the incidence of adverse reactions.
引文
[1]刘钢,温兆赢.心肌炎的磁共振诊断价值及最新进展[J].心肺血管病杂志,2016,35(4):338-340.
[2]高见书,汪芳.心电图表现酷似急性冠状动脉综合征的急性病毒性心肌炎20例临床分析[J].中国动脉硬化杂志,2015,23(3):307-309.
[3]戴娜,卜丽梅,付军.病毒性心肌炎的研究进展[J].中国老年学杂志,2014,34(18):5318-5321.
[4]中华心血管病杂志编辑委员会心肌炎心肌病对策专题组,杨英珍.关于成人急性病毒性心肌炎诊断参考标准和采纳世界卫生组织及国际心脏病学会联合会工作组关于心肌病定义和分类的意见[J].中华心血管病杂志,1999,27(6):405-407.
[5]张冬梅.急性心肌炎19例误诊分析[J].临床误诊误治,2013,26(2):42-44.
[6]朱纪芳,汪小华,陆敏霞. 2例重症心肌炎并发急性胰腺炎患者的护理[J].中华护理杂志,2014,49(9):1150-1152.
[7]宁尚秋,尼玛,伊比然恨,等. ST段抬高与非ST段抬高的成人急性心肌炎临床特点比较[J].中华急诊医学杂志,2017,26(6):697-702.
[8]范修才.急性心肌梗死行经皮腔内冠脉介入治疗后心电图ST段回落情况与预后的关系[J].中西医结合心血管病电子杂志,2018,6(16):64-65.
[9]阮婕,沈洪丽.小儿病毒性心肌炎的心电图临床分析[J].中国基层医药,2016,23(15):2384-2386.
[10]周娟.肾综合征出血热合并病毒性心肌炎心脏损害患者动态心电图变化探究[J].中国医学前沿杂志(电子版),2017,9(8):146-149.
[11] LIN K M,LI M H,HSIEH K S,et al. Impact of extracorporeal membrane oxygenation on acute fulminant myocarditis-related hemodynamic compromise arrhythmia in children[J]. Pediatr Neonatol,2016,57(6):480-487.
[12]胡伟航,刘长文,胡炜,等.体外膜肺氧合治疗暴发性心肌炎患者的临床研究[J].中华危重症医学杂志(电子版),2016,9(6):371-375.
[13]夏源园,龚方戚.儿童暴发性心肌炎的早期诊断及治疗进展[J].临床儿科杂志,2016,34(11):866-870.
[14]黄煜,林军华,吴佳易,等. 30例急性重症心肌炎患者的临床特征及治疗策略[J].临床心血管病杂志,2014,30(2):104-107.
[15]范玉菲,邹海英,王咏梅,等.成人暴发性心肌炎患者的护理体会[J].心脑血管病防治,2015,15(5):426-427.
[16]张行丰,过小叶.不同血管活性药物在治疗感染性休克中的临床应用[J].中华全科医学,2014,12(4):651-652.
[17]陈斓,胡伟航,刘长文.暴发性心肌炎治疗及机械循环辅助进展[J].心电与循环,2016,35(2):118-120,124.
[18]曾令恒,赵艳华,何思杰,等. c TnI、Mb、CK-MB联合检测在急性心肌梗死诊断中的临床价值[J].中国实用医药,2017,12(12):65-66.
[19]张辉,王茜.环磷腺苷葡胺对急性心肌梗死患者心功能及氧化应激水平的影响[J].中国生化药物杂志,2017,37(5):98-100.
[20]田娟,李莉.心肌损伤标志物危急值的验证[J].标记免疫分析与临床,2017,24(6):606-609,626.
[21]宁尚秋,伊比然恨,尼玛,等.成年女性急性心肌炎的临床特点分析[J].心肺血管病杂志,2017,36(5):334-337.
[22]吴琳琳,韩波.心肌炎的诊断与治疗[J].中国当代儿科杂志,2014,16(12):1283-1288.
[23]廖小卒,李斌飞,程周,等.成人爆发性心肌炎患者应用体外膜肺氧合临床预后及危险因素分析[J].实用医学杂志,2016,32(2):257-260.
[24]周靖,戴允浪.成人急性心肌炎的病例特点分析[J].中国继续医学教育,2016,8(26):109-111.
[2]高见书,汪芳.心电图表现酷似急性冠状动脉综合征的急性病毒性心肌炎20例临床分析[J].中国动脉硬化杂志,2015,23(3):307-309.
[3]戴娜,卜丽梅,付军.病毒性心肌炎的研究进展[J].中国老年学杂志,2014,34(18):5318-5321.
[4]中华心血管病杂志编辑委员会心肌炎心肌病对策专题组,杨英珍.关于成人急性病毒性心肌炎诊断参考标准和采纳世界卫生组织及国际心脏病学会联合会工作组关于心肌病定义和分类的意见[J].中华心血管病杂志,1999,27(6):405-407.
[5]张冬梅.急性心肌炎19例误诊分析[J].临床误诊误治,2013,26(2):42-44.
[6]朱纪芳,汪小华,陆敏霞. 2例重症心肌炎并发急性胰腺炎患者的护理[J].中华护理杂志,2014,49(9):1150-1152.
[7]宁尚秋,尼玛,伊比然恨,等. ST段抬高与非ST段抬高的成人急性心肌炎临床特点比较[J].中华急诊医学杂志,2017,26(6):697-702.
[8]范修才.急性心肌梗死行经皮腔内冠脉介入治疗后心电图ST段回落情况与预后的关系[J].中西医结合心血管病电子杂志,2018,6(16):64-65.
[9]阮婕,沈洪丽.小儿病毒性心肌炎的心电图临床分析[J].中国基层医药,2016,23(15):2384-2386.
[10]周娟.肾综合征出血热合并病毒性心肌炎心脏损害患者动态心电图变化探究[J].中国医学前沿杂志(电子版),2017,9(8):146-149.
[11] LIN K M,LI M H,HSIEH K S,et al. Impact of extracorporeal membrane oxygenation on acute fulminant myocarditis-related hemodynamic compromise arrhythmia in children[J]. Pediatr Neonatol,2016,57(6):480-487.
[12]胡伟航,刘长文,胡炜,等.体外膜肺氧合治疗暴发性心肌炎患者的临床研究[J].中华危重症医学杂志(电子版),2016,9(6):371-375.
[13]夏源园,龚方戚.儿童暴发性心肌炎的早期诊断及治疗进展[J].临床儿科杂志,2016,34(11):866-870.
[14]黄煜,林军华,吴佳易,等. 30例急性重症心肌炎患者的临床特征及治疗策略[J].临床心血管病杂志,2014,30(2):104-107.
[15]范玉菲,邹海英,王咏梅,等.成人暴发性心肌炎患者的护理体会[J].心脑血管病防治,2015,15(5):426-427.
[16]张行丰,过小叶.不同血管活性药物在治疗感染性休克中的临床应用[J].中华全科医学,2014,12(4):651-652.
[17]陈斓,胡伟航,刘长文.暴发性心肌炎治疗及机械循环辅助进展[J].心电与循环,2016,35(2):118-120,124.
[18]曾令恒,赵艳华,何思杰,等. c TnI、Mb、CK-MB联合检测在急性心肌梗死诊断中的临床价值[J].中国实用医药,2017,12(12):65-66.
[19]张辉,王茜.环磷腺苷葡胺对急性心肌梗死患者心功能及氧化应激水平的影响[J].中国生化药物杂志,2017,37(5):98-100.
[20]田娟,李莉.心肌损伤标志物危急值的验证[J].标记免疫分析与临床,2017,24(6):606-609,626.
[21]宁尚秋,伊比然恨,尼玛,等.成年女性急性心肌炎的临床特点分析[J].心肺血管病杂志,2017,36(5):334-337.
[22]吴琳琳,韩波.心肌炎的诊断与治疗[J].中国当代儿科杂志,2014,16(12):1283-1288.
[23]廖小卒,李斌飞,程周,等.成人爆发性心肌炎患者应用体外膜肺氧合临床预后及危险因素分析[J].实用医学杂志,2016,32(2):257-260.
[24]周靖,戴允浪.成人急性心肌炎的病例特点分析[J].中国继续医学教育,2016,8(26):109-111.