急性前壁心肌梗死患者aVR导联ST段变化的临床意义  

The Clinical Significance of ST Segment Changes of aVR Lead in Patients with Acute Anterior Wall Myocardial Infarction.

作　　者：沈文均[1] 周建庆[1] 葛世俊[1] 周军波[1] 柳俊平[1] 缪群[2] 梁雪 

机构地区：[1]宁波市医疗中心李惠利医院,浙江宁波315041 [2]杭州市第一人民医院,浙江杭州310006 [3]郑州市铁路中心医院,河南郑州450000

出　　处：《心脑血管病防治》2006年第3期142-145,共4页CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT

摘　　要：目的 探讨急性前壁心肌梗死患者aVR导联ST段变化的临床意义。方法首次急性前壁心肌梗死患者75例，均经再灌注治疗及冠状动脉造影，依据心电图aVR导联ST段变化将病例分为抬高组、无偏移组和下移组。结果前降支再灌注TIMI分级0-1级在ST段抬高组、无偏移组、下移组分别为15例（78．9％）、31例（91．2％）、21例（95．5％），后两组与ST段抬高组比较有显著差异（P〈0．05）。相对2～3级血流也类似情况，ST段抬高组与后两组比较有显著差异（P〈0．01），犯罪血管为左主干病变的ST段抬高组、无偏移组、下移组分别为4例（21．1％）、1例（2．9％）、3例（13．6％），有显著差异（P〈0．01）；病变范围为前降支近端至S1，病变范围为前降支近端至D1，三组无明显差异，多支病变和侧支循环形成2级以上ST段抬高组与无偏移组，下移组与无偏移组均有显著差异（P〈0．05）；早期临床情况显示ST段抬高组和ST段下移组的血清BNP和cTnI明显高ST段无偏移组（P〈0．05）；ST段抬高组和下移组行CABC和IABP应用明显高于无偏移组（P〈0．01），而左室射血分数（LVEF）无明显差异（P〉0．05）。结论急性前壁心肌梗死患者如果aVR导联ST段抬高或下移可能提示有严重的左主干病变，左前降支病变或严重的多支病变，且有大面积的心肌梗死，心肌收缩功能损害明显。Objective To evaluate the clinical significance of ST segment changes of aVR lead in patients with acute anterior wall myocardial infarction. Methods From Jan. 2000 to Mar. 2005, 75 inpatients with acute anterior wall myocardial infiarction who all underwent reperfusion and CAG were analyzed and divided into elevation group, no drift group, no drift group and depressed group according to the ST segment changes of aVR lead. Results （1）. There were 15 eases （78.9%）, 31 eases （91.2%） and 21 eases （95.5%）with TIMIgrade 0 - 1 in anterior descending branch after reperfusiun in elevation group, no drift group and depressed group, respectiovely. There was a significant difference between the latter two groups and elevation group （ P 〈 0.05）. The similar instance was seen in TIMIgrade 2 - 3, but the difference was even more significant （ P 〈 0.01）. （2）. The patients whose criminal vessel was loft main coronary artery were significantly more in devation group （4 cases, 21.1% ） than in no drift group （1 cases, 2.9% ）and depressed group （3 cases, 13.6 % ）（ P 〈 0.01）. There was no significant difference for lesion dimension from anterior descending branch to S1 or to D1 among these three groups. The eases with multi - vessd lesions and collateral circulation formation 〉 2 grade in elevation group and depressed group were significantly more than in no drift group （ P 〈 0.05）. Serum BNP and cTnl concentration were significantly higher in elevation group and depressed group than in no drift group （ P 〈 0.05）. The application rates of CABG and IABP were significantly higher in elevation group and depressed group than in no drift group （ P 〈 0.01）. There was no significant difference for left ventricular ejection fraction among these three groups （ P 〉 0.05 ）. Conclusions Elevation or depression in ST segment of aVR lead in patients with acute anterior wall myocardial infarction indicated serious in left main coronary artery, left anterior descending branc

关 键 词：心肌梗死 心电图 AVR导联 ST段 冠状动脉造影 

分 类 号：R542.22[医药卫生—心血管疾病]