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上图中的一系列心电图表现为类似1842年推出的德军头盔，称为“Spiked Helmet” Sign。有学者通过对一系列临床病例的观察发现，患者如果出现此类心电图标志往往提示病情危重，有死亡风险。但该征象的具体形成机制尚不清楚，有一些医学观察指向了膈肌刺激。该心电图征象可见于主动脉夹层、气胸（出现在胸前导联）以及肠穿孔、肠梗阻（出现在下壁导联）等危重病例。 References: 1. Littmann L, Monroe MH. Tombstone ST elevation without myocardial infarction: A variant of the “Spiked Helmet” sign? The American Journal of Medicine 2013;126(8):e9–10. 2. Littmann L, Monroe MH. The “Spiked Helmet” sign: A new Electrocardiographic marker of critical illness and high risk of death. Mayo Clinic Proceedings 2011;86(12):1245–6. 3. Agarwal A, Janz T, Garikipati N. Spiked helmet sign: An under-recognized electrocardiogram finding in critically ill patients. Indian Journal of Critical Care Medicine 2014;18(4):238. 4. Hibbs J, Orlandi Q, Olivari MT, Dickey W, Sharkey SW. Giant J waves and sT-segment elevation associated with acute gastric distension. Circulation 2016;133(11):1132–4. 5. Littmann L. Letter by Littmann regarding article, “Giant J waves and sT-segment elevation associated with acute gastric Distension.” Circulation 2016;134(8):e109–10. 6. Littmann L, Proctor P. Real time recognition of the electrocardiographic “spiked helmet” sign in a critically ill patient with pneumothorax. International Journal of Cardiology 2014;173(3):e51–2. 7. Tomcsányi J, Frész T, Proctor P, Littmann L. Emergence and resolution of the electrocardiographic spiked helmet sign in acute noncardiac conditions. The American Journal of Emergency Medicine 2015;33(1):127.e5–127.e7.
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