前壁急性心肌梗死V_1和V_(3R)导联ST段变化与冠状动脉分布的关系  

Relation Between the Pattern of ST Segment in Leads V1 and V3R and Distributionof Coronary Arteries During Anterior Wall Acute Myocardial Infarction

作　　者：杨树森[1] 林继红[1] 周立君 李为民 孟繁超 黄永麟 

机构地区：[1]哈尔滨医科大学附属第一医院

出　　处：《中国循环杂志》1998年第4期194-195,共2页Chinese Circulation Journal

摘　　要：目的：探讨前壁急性心肌梗死病人Ｖ１和Ｖ３Ｒ导联ＳＴ段变化与冠状动脉分布的关系。方法：前壁急性心肌梗死病人３４例，入院时均采集标准１２导联及Ｖ３Ｒ导联心电图，入院１０天内进行冠状动脉造影，评价心电图变化与冠状动脉分布的关系。根据Ｖ１导联ＳＴ段抬高幅度将病人分为两组：Ａ组（ＳＴ段抬高≥１．５ｍｍ，１５例）和Ｂ组（ＳＴ段抬高＜１．５ｍｍ，１９例）。将起源于右冠状动脉的圆锥动脉分为两种类型：小圆锥支型和大圆锥支型。结果：Ｖ３Ｒ导联ＳＴ段抬高在Ａ组和Ｂ组分别为１４例（９３％）和６例（３２％，Ｐ＜０．００１），小圆锥支型者在Ａ组和Ｂ组分别为１２例（８０％）和３例（１５％，Ｐ＜０．００１），大圆锥支型者１３例，均来自Ｂ组。结论：前壁急性心肌梗死病人入院时Ｖ１导联ＳＴ段抬高与Ｖ３Ｒ导联ＳＴ段抬高密切相关，均为小圆锥支型者。前壁急性心肌梗死Ｖ１导联无ＳＴ段抬高，表明除左前降支的间隔支供血外，心室间隔还得到大圆锥支型的血液供应而受到保护。? Objective:To explore the relation between the pattern of ST segment in leads V1 and V3R and distribution of coronary arteries during anterior wall acute myocardial infarction. Methods:The standard 12lead ECG with additional lead V3R and admission were collected to assess the relation between the changes of ECG and distribution of coronary arteries in 34 patients with anterior wall acute myocardial infarction (AMI).Patients were classified into two groups according to the magnitude of ST segment elevation in lead V1:group A(elevation≥15 mm,n=15)and group B(elevation<15 mm,n=19).Two types(small and large)of conal branch from the right coronary artery were identified. Results:ST segment elevation in lead V3R was seen in 14(93%)and 6(32%)patients from group A and group B,respectively(p<0001):a small conal branch was found in 12(80%)and 3(15%)patients,respectively(p<0001).Thirteen patients(all from group B)had a large conal branch. Conclusions:ST segment elevation in Lead V1 in the admission ECG of patients with anterior wall AMI is strongly related to ST segment elevation in lead V3R and is associated with a small conal branch.The absence of ST segment elevation in lead V1 during anterior AMI suggests that the IVS is protected by a large conal branch in addition to the septal branches of LAD.

关 键 词：心肌梗死 AWAMI V1导联ST段 V3R导联ST段 

分 类 号：R542.22[医药卫生—心血管疾病]