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《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

19卷

期数:

2013年06期

页码:

464-467

栏目:

临床医学

出版日期:

2013-11-20

文章信息/Info

Title:

Study on predictability of ECG for the infarct-related artery of patients with acute inferior myocardial infarction

作者:

赵学伟¹; 李 连¹; 车京津²; 师艳莉¹

１．天津医科大学研究生院，天津 ３０００７０；２．天津医科大学第二医院心脏科，天津 ３００２１１

Author(s):

ZHAO Xue-wei¹;  LI Lian¹;  CHE Jing-jin²;  SHI Yan-li¹

1. Graduate School，Tianjin Medical University，Tianjin 300070，China；2. Department of Cardiology，The Second Hospital，Tianjin Medical University，Tianjin 300211，China

关键词:

急性下壁心肌梗死; 心电图; 冠状动脉造影

Keywords:

acute inferior myocardial infarction; electrocardiogram; coronary angiography

分类号:

R542.2+2

DOI:

-

文献标志码:

A

摘要:

目的：探讨急性下壁心肌梗死（ＡＩＭＩ）心电图（ＥＣＧ）改变与冠状动脉病变关系。方法：对94例AIMI患者的心电图改变与冠状动脉造影对比分析。结果：94例AIMI患者的心电图Ⅲ导联与Ⅱ导联ST段抬高之比（STEⅢ/Ⅱ）＞1、≤1分别为73例、21例。73例STEⅢ/Ⅱ＞1者，梗死相关动脉（IRA）为右冠状动脉（RCA）、回旋支（LCX）者分别为65例、7例，1例IRA为第一对角支（D1）；21例STEⅢ/Ⅱ≤1者IRA为RCA、LCX分别为9例、12例，差异有统计学意义（P＜0.05）。73例STEⅢ/Ⅱ＞1 AIMI患者， ECG伴V1~V6导联ST段压低（STD V1-6）36例，不伴STD V1-6为10例，两组表现为除IRA病变外，合并前降支（LAD）病变分别为18例（50%）和1 例（10%），差异有统计学意义（P＜0.05）。21例STEⅢ/Ⅱ≤1 AIMI者, ECG伴STDV1-6为5例，不伴STDV1-6为3例，伴STDV1-3压低同时STEV4-6为4例，3组合并LAD病变分别为4 例（80%）、0例（0）和2例（50%），差异有统计学意义（P＜0.０５）。30例合并右室梗死者IRA为RCA者29例（96.67%），且多为RCA开口或近段病变（65.52%），合并住院期间恶性心律失常（室速、室颤或Ⅲ°AVB）共7例（63.64%）。结论：AIMI 患者ECG下壁导联STEⅢ/Ⅱ的比值有助于鉴别IRA为LCX或RCA；合并胸前导联ST段改变与LAD病变有关；表现为下壁合并右室梗死者多为RCA近段病变，梗死面积更大，预后更差。

Abstract:

Objective: To investigate the relationship between ECG changes of AIMI (acute inferior myocardial infarction) patients and their coronary artery lesions. Methods：ECG changes and coronary angiography were compared in the ninety four patients with AIMI. Results：Of the 94 AIMI patients, 73 cases had STEⅢ/Ⅱabove 1，and 21 were below or equal to 1. In the 73 cases（STEⅢ/Ⅱ>1），sixty-five cases’ IRA (infarct-related artery) were RCA (the right coronary artery), one patient’ IRA was first diagonal branch (D1), and the remaining 7 cases were LCX (left circumflex artery). In the 21cases （STEⅢ/Ⅱ≤1）, RCA and LCX regarded as IRA were 9 and 12 cases respectively (P<0.05). In the 73 AIMI patients with STEⅢ/Ⅱabove 1 , thirty six had depression of ST segment on precordial leads V1 to V6(STD V1-6), and ten cases had no depression of ST segment on precordial leads V1 to V6 (non-STD V1-6). Except the IRA, the number of LAD (anterior descending artery) lesions additionally were 1 (10%) and 18 (50%) respectively, the difference between STD V1-6 and non-STD V1-6 had statistically significant (P<0.05). In the 21 AIMI patients with STEⅢ/Ⅱbelow and equal to 1, five cases had STD V1-6，three had non- STD V1-6, and combined STDV1-3 and STEV4-6 were 34. The additionally LAD lesions were 4 cases (80%), 0 (0), 2(50%) respectively, the difference between the ratio of LAD lesions had statistically significant (P<0.05). In the inferior wall of 30 patients with right ventricular myocardial infarction, 29 (96.67%) cases’ IRA were RCA. Lesions at the beginning or proximal were more prevalence (65.52%) in RCA. Malignant arrhythmias were diagnosed in 7 patients (63.64%) during hospitalization. Conclusion: The ratio of STEⅢ/Ⅱ can help to identify AIMI patient’s IRA , LCX or RCA lesion; precordial ST segment changes can predict LAD lesions additionally; In patients with inferior wall infarction combined with right ventricular, the lesions prone to occupy the beginning or proximal of RCA, infarct size tend to be wider, and prognosis likely more worse.

参考文献/References:

[1] 姚依群，周书明，郭惠萍.下壁心肌梗死患者心电图 V1V2 导联 ST 段压低的临床意义[J]. 中国医师杂志, 2002, 4(4): 405
[2］ Sezer M, Nisanci Y, Umman B, et al. New support for clarifying the relation between ST segment resolution and microvascular function: degree of ST segment resolution correlates with the pressure derived collateral flow index[J]. Heart, 2004, 90(2): 146
[3］ 丁雅英, 唐继志. 急性下壁心肌梗死伴胸导联 ST 段压低的临床意义[J]. 心电学杂志, 2004, 23(2): 74
[4］ 马会利,陈纪林. 心电图判断急性心肌梗死病人梗死相关血管的临床价值[J]. 心血管病学进展, 2001, 22(1): 28
[5］ 席锐, 刘霞, 陆国平. 急性心肌梗死对应导联 ST 段下移的研究进展[J]. 心血管病学进展, 2004, 25(4): 268
[6］ Kosuge M, Kimura K, Ishikawa T, et al. New electrocardiographic criteria for predicting the site of coronary artery occlusion in inferior wall acute myocardial infarction[J]. Am J Cardiol, 1998, 82(11): 1318
[7］ Lee H W, Hong T J, Yang M J, et al. Comparison of infarct-related artery vs multivessel revascularization in ST-segment elevation myocardial infarction with multivessel disease: Analysis from Korea Acute Myocardial Infarction Registry[J]. Cardiol J, 2012, 19(3): 256
[8］ 张晓江, 颜红兵，郑斌, 等. 体表心电图错误判断或无法判断梗死相关动脉的原因分析[J]. 中华心血管病杂志, 2010, 38(10): 914
[9］ Scott P J, Navarro C, Stevenson M, et al. Optimization of the precordial leads of the 12-lead electrocardiogram may improve detection of ST-segment elevation myocardial infarction[J]. J Electrocardiol, 2011, 44(4): 425
[1０］ Boon-Lock C, Yip J W, Huay-Cheem T. Usefulness of ST elevation, Ⅱ/Ⅲ ratio and ST deviation in lead Ⅰ for identifying the culprit artery in inferior wall acute myocardial infarction[J]. Am J Cardiol, 2000, 86(3): 341
[1１］ 许玉韵, 胡大一. 心电图与冠状动脉造影: 附 201 例心电图与冠脉造影对照分析 [M].北京：人民卫生出版社，2006:10-10
[1２］ Bayram E, Atalay C. Identification of the culprit artery involved in inferior wall acute myocardial infarction using electrocardiographic criteria[J]. J Inter Med Res, 2004， 32(1): 39
[1３］ 李爱英. 急性 ST 段抬高型心肌梗死病人心电图对梗死相关动脉预测价值分析[J]. 内蒙古医科大学学报, 2013，35(01S): 53
[1４］ 邬松林, 黄从新, 王晋明. 急性下壁心肌梗死时 Ⅲ 导联 ST 段抬高大于 Ⅱ 导联的临床意义[J]. 中国心脏起搏与心电生理杂志, 2000， 14(3): 4
[1５］ Birnbaum Y, Wagner G S, Barbash G I, et al. Correlation of angiographic findings and right (V1 to V3) versus left (V4 to V6) precordial ST-segment depression in inferior wall acute myocardial infarction[J]. Am J Cardiol, 1999, 83(2): 143

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备注/Memo

备注/Memo:

作者简介 赵学伟（1986-），男，硕士在读，研究方向：冠心病基础与临床；通信作者：车京津，E-mail：jingjinche@aliyun.com。

常用功能

更新日期/Last Update: 2013-12-20