Dzięcioł Małgorzata, Kacprzak Michał, Goleniewska Beata, Zielińska Marzenna
Acta Cardiol. 2014 Oct;69(5):532-40. doi: 10.1080/ac.69.5.3044880.
Experimental and clinical studies have proven the neuroprotective effects of hypothermia in unconscious patients with spontaneous circulation after out-of-hospital cardiac arrest. Based on this evidence, recommendations have been made to incorporate mild therapeutic hypothermia into practice. ECG changes are well documented in people with incidental hypothermia but there are only few studies on ECG abnormalities in patients undergoing mild therapeutic hypothermia after cardiac arrest due to ST-elevation myocardial infarction.
Ten patients with ST-elevation myocardial infarction (STEMI) complicated by cardiac arrest and receiving mild therapeutic hypothermia (MTH) after return of spontaneous circulation and ten comparable patients but not receiving mild therapeutic hypothermia as a control group were incorporated into our prospective study. We analysed electrocardiographic (ECG) changes during hypothermia and its influence on ECG evolution in patients after STEMI.
MTH was mainly associated with decrease of heart rate (P = 0.014) and QTc interval prolongation (P = 0.005). In 60% of patients the Osborn wave was registered. The presence of a new Q wave or new negative T wave in ECGs registered on the 3rd day of STEMI was comparable in the two groups.
Although hypothermia is associated with typical ECG findings like Osborn wave, the electrocardiographic evolution of STEMI in patients receiving MTH is comparable with that in patients without it.
实验和临床研究已证实低温对院外心脏骤停后自主循环恢复的昏迷患者具有神经保护作用。基于这一证据，已提出将轻度治疗性低温纳入临床实践的建议。意外低温患者的心电图变化已有充分记录，但关于因ST段抬高型心肌梗死导致心脏骤停后接受轻度治疗性低温的患者心电图异常的研究却很少。
将10例ST段抬高型心肌梗死（STEMI）合并心脏骤停且自主循环恢复后接受轻度治疗性低温（MTH）的患者，以及10例情况相当但未接受轻度治疗性低温作为对照组的患者纳入我们的前瞻性研究。我们分析了低温期间的心电图（ECG）变化及其对STEMI患者心电图演变的影响。
MTH主要与心率降低（P = 0.014）和QTc间期延长（P = 0.005）相关。60%的患者记录到了J波。STEMI第3天记录的心电图中出现新的Q波或新的负向T波在两组中相当。
尽管低温与J波等典型心电图表现相关，但接受MTH的STEMI患者的心电图演变与未接受MTH的患者相当。
