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目的探讨心电图ST段抬高误诊为急性心肌梗死(AMI)的原因。方法对22例因ST段抬高被误诊AMI的临床资料进行回顾性分析。结果22例患者中,男19例,女3例;年龄(54.54±13.71)岁,其中45岁以下者17例,占77.3%。全部病例均以冠心病或AMI收入院,其中早期复极综合征7例(31.8%),迷走神经张力增强5例(22.7%),室壁瘤2例(9.1%),肺栓塞2例(9.1%),Brugada综合征2例(9.1%),急性心包炎1例(4.5%),心脏挫伤2例(9.1%),胸主动脉瘤1例(4.5%)。结论心电图有ST段的抬高且伴有胸痛症状的患者易于误诊为冠心病或AMI,应注意鉴别。不能孤立地看待ST段的改变,要结合ST段的形态、心率、QRS波群等进行综合分析。
Objective To investigate the causes of misdiagnosis of ST segment elevation in ECG as acute myocardial infarction (AMI). Methods The clinical data of 22 AMI patients misdiagnosed by ST segment elevation were analyzed retrospectively. Results Among the 22 patients, 19 were males and 3 were females. The age was (54.54 ± 13.71) years, of which 17 were under 45 years old, accounting for 77.3%. All patients were admitted to hospital with coronary heart disease or AMI, including 7 cases of early repolarization syndrome (31.8%), 5 cases of vagal tone enhancement (22.7%), 2 cases of aneurysm (9.1%), 2 cases of pulmonary embolism ), Brugada syndrome in 2 (9.1%), acute pericarditis in 1 (4.5%), heart contusion in 2 (9.1%) and thoracic aortic aneurysm in 1 (4.5%). Conclusions Patients with elevation of ST segment and chest pain in ECG may be easily misdiagnosed as coronary heart disease or AMI. ST segment changes can not be viewed in isolation, combined with ST segment morphology, heart rate, QRS complex and so on a comprehensive analysis.