从心电图aVR导联判断急性前壁、下壁心肌梗死的意义  

The Value of Lead aVR in Identifying the Infarctrelated Artery in Patients with Acute Anterior or Inferior Myocardial Infarction

作　　者：黄璐璐 吴子平[1,2] 吴佳逢 罗林杰 梁旭[1,2] 

机构地区：[1]深圳市人民医院 [2]暨南大学医学院第二临床医院心电图室,广东深圳518020

出　　处：《广州医学院学报》2009年第2期73-75,共3页Academic Journal of Guangzhou Medical College

摘　　要：目的:从心电图aVR导联判断急性前壁、下壁心肌梗死患者梗死相关血管(IRA)的意义。方法:选择本院2006年1月-2008年11月,首次因急性前壁心肌梗死89例和急性下壁心肌梗死75例,对比两者心电图aVR导联、冠脉造影、超声心动图结果的改变。结果:IRA为左主干(LM)8例、左前降支(LAD)81例、左回旋支(LCX)17例和右冠状动脉(RCA)58例。以aVR导联ST段压低≥1 mm为诊断标准,诊断LCX为IRA的敏感度为76.5%,特异度为94.8%,阳性预测值为81.3%,阴性预测值93.2%;而对RCA诊断的敏感度、特异度均低。aVR导联ST段抬高≥0.5 mm,其预测IRA为LM的敏感度为75%、特异度74.1%、阳性预测值22.2%、阴性预测值96.7%。对LM+LAD近段预测的敏感度为51.1%、特异度92.8%、阳性预测值88.9%、阴性预测值62.9%。结论:急性前壁、下壁心肌梗死患者心电图aVR导联ST段改变用于判断患者的IRA和预后有一定的临床意义。Objective： To predict the infarct-related artery （IRA） in patients with acute anterior or inferior myocardial infarction （MI） by ECG lead aVR. Methods： We studied 89 patients with acute anterior MI and 75 patients with acute inferior MI hospitalized from January 2006 to November 2008. The result of ECG, echocardiography and coronary angiography were obtained and contrasted in all patients. Result： There were 8 patients whose IRA were left main stem （LM） ,81 patients left anterior descending coronary artery （LAD） , 17 patients left circumflex artery （LCX） and 58 patients right coronary artery （RCA）. The sensitivity （Se） ,specificity （Sp） ,positive predictive value （PPV） , negative predictive value （NPV） of ST-segment depressions〉 1 mm in lead aVR for LCX as IRA were 76.5% ,94.8% , 81.3% ,93.2% ,respectively. The Se and Sp were low in RCA. The Se,Sp,PPV and NPV of ST-segment elevations〉 0.5 mm in lead aVR for LM as IRA was 75% ,74.1% ,22.2% ,96.7% ,respectively. The Se,Sp,PPV and NPV of ST-segment elevations〉0.5 mm in lead aVR for the LM ＋ proximal LAD as IRA was 51. 1% ,92.8% ,88.9% ,62. 9% , respectively. Conclusions： The ST-segment change in lead aVR were useful for predicting and diagnosticate IRA in patients with acute anterior or inferior myocardial infarction.

关 键 词：心电图 AVR导联 ST段 急性前壁 下壁心肌梗死 梗死相关血管 

分 类 号：R542.2[医药卫生—心血管疾病]