aVR导联ST段偏移性急性下壁心肌梗死的犯罪血管判断及预后分析  

Value of ST segment in lead aVR in predicting criminal vessel in inferior wall of acute myocardial infarction and prognostic analysis

作　　者：陈青萍[1] 黄学成[1] 邓梓谦[1] 张凤玲[1] 黄宁[1] 

机构地区：[1]广西医科大学第三附属医院心电诊断科,广西南宁530031

出　　处：《临床荟萃》2009年第24期2121-2123,共3页Clinical Focus

摘　　要：目的研究aVR导联ST段偏移对急性下壁心肌梗死(IAMI)犯罪血管的判断及预后分析。方法收集2000～2008年IAMI(包括同时伴右心室梗死)76例,按入院时aVR导联ST段有否偏移分为aVR导联ST段偏移组37例,无ST段偏移组39例,全部患者行冠状动脉造影术(发病后8小时内),根据冠状动脉造影及临床资料,分析患者冠状动脉病变部位及临床预后。结果①ST段偏移组37例患者中,aVR导联ST段抬高26例,其中右冠状动脉(RCA)闭塞24例,左回旋支(LCX)闭塞2例;aVR导联ST段下移11例,其中RCA闭塞1例,LCX闭塞10例。②无ST段偏移组39例患者中,RCA闭塞37例,LCX闭塞2例。③ST段偏移组合并有糖尿病、并发症、心肌梗死后心绞痛的发生率及住院病死率均明显高于无ST段偏移组;ST段偏移组PCI后心肌缺血再灌注损伤的发生率明显高于无ST段偏移组。结论aVR导联ST段偏移情况对预测IAMI的犯罪血管、判断病情预后有较好的参考价值,是梗死相关动脉成功再通后心肌缺血再灌注损伤的强力预测因素。Objective To investigate the value of ST segment in lead aVR in predicting the criminal vessel in inferior wall of acute myocardial infarction（IAMI） and prognostic analysis.Methods Seventy-six patients with IAMI in 2000-2008,including cases accompanied with right ventricular myocardial infarction,were divided into ST segment shift lead aVR group with 37 cases and non ST segment shift in lead aVR group with 39 cases according to ST segment deviation or not.All of them accepted coronary angiography in 8 hours since onsets.The coronary artery lesion sites and prognosis were analyzed according to the results of angiography and clinical materials.Results In ST segment shift in lead aVR group,there were 26 cases with ST segment elevation in lead aVR,including 24 cases with right coronary artery （RCA） occlusion,2 cases with left circumflex artery （LCX） occlusion,and there were 11 cases with ST segment depression in lead aVR,including 1 case with RCA occlusion,10 cases with LCX occlusion.In non ST segment shift in lead aVR group with 39 cases,there were 37 cases with RCA occlusion,2 cases with LCX occlusion.On the other hand,the fatality rates of companying with diabetes,complication,postinfarction angina,myocardial ischemia-reperfusion injury after PCI and hospital mortality were higher in ST segment shift in lead aVR group than in non ST segment shift group.Conclusion ST segment shift or not in lead aVR has significant value in predicting the criminal vessel in IAMI and prognostic analysis,and it is strength predictor in ischemia-reperfusion injury.

关 键 词：心肌梗死 心电描记术 冠状血管造影术 

分 类 号：R542.22[医药卫生—心血管疾病]