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急性心肌梗塞(AMl)极早期,病理性 Q 波尚未出现时,ECG 诊断有一定难度。自1975年Schamroth 提出 AMI 的早期超急性损伤期理论之后,对于 AMI 的早期 ECG 改变有了较统一的认识,即可有以下表现:(1)急性损伤阻滞。①对应梗塞导联的 R 波升肢缓慢,因此类本位曲折≥0.045s,②QRS 间期增宽,可达0.12s,③常有 QRS 波幅增加。(2)ST 段斜行抬高可达10—15mm。(3)T 波电压增加,T 波高耸。我科1980—1990年共收治 AMI 267例。首次 ECG呈不典型表现者119例(44.5%)。其中大多数基本符合 Schamroth 标准。尚有少数呈 AMI 极早期的不典型表现,而动态观察描记 ECG 演变过程及临床症状、体征、心肌酶等均符合 AMI
Early acute myocardial infarction (AMl), pathological Q wave has not yet appeared, ECG diagnosis has some difficulty. Since Schamroth proposed the theory of early hyperacute injury of AMI in 1975, there is a more uniform understanding of the early ECG changes of AMI. The following findings can be obtained: (1) acute injury block. ① corresponding to the lead of the infarction R wave slow rise, so the class of tortuous ≥ 0.045s, ② QRS interval widening, up to 0.12s, ③ often increased QRS amplitude. (2) ST segment inclined up to 10-15mm. (3) T wave voltage increases, T wave towering. My department from 1980 to 1990 were treated 267 cases of AMI. The first ECG showed atypical manifestations in 119 cases (44.5%). Most of them basically meet the Schamroth standard. There are a few cases of AMI very early atypical manifestations, and dynamic observation of ECG evolution and clinical symptoms, signs, myocardial enzymes, etc. are in line with AMI