aVR导联ST段抬高在急性冠脉综合征危险分层中的临床意义  

Clinical significance of ST-segment elevation in lead aVR to risk stratification in acute coronary syndromes

作　　者：肖霖[1] 赵丽萍[1] 张国辉[2] 

机构地区：[1]江苏大学附属人民医院心电图室,江苏镇江212002 [2]江苏大学附属人民医院心内科,江苏镇江212002

出　　处：《现代医药卫生》2011年第21期3218-3221,共4页Journal of Modern Medicine & Health

摘　　要：目的:分析心电图aVR导联ST段抬高[aVR(+)]与临床变量和心肌梗死溶栓(TIMI)危险度评分组合在不稳定心绞痛和非ST段抬高心肌梗死(UA/NSTEMI)的价值与意义。方法:在205例患有UA/NSTEMI的病人中,选择入院心电图aVR(+)超过0.5 mm的进行回顾性评估。结果:入院aVR(+)是30天死亡率有力而独立的预测因素。死亡率随aVR(+)的严重性而增加。对于临床因素低危组病人(肌钙蛋白阴性,心率≤110次/分,收缩压>90 mmHg,入院符合心功能Killip I级,年龄≤70岁),aVR(+)的病人比无aVR(+)有更高的死亡率。在TIMI危险度评分的低危组和中危组里,aVR(+)的病人比没有aVR(+)的病人有更高的死亡率。结论:aVR(+)对UA/NSTEMI病人有重要价值,而且能够为临床危险因素及TIMI危险度评分对ACS病人危险分层及预后提供重要的价值,尤其对于低危组和中危组的病人。【Objective：To analyze the value and significance of ST elevation in lead aVR [aVR（＋）] in initial standard electrocardiogram（ECG） performed on admission in combination with clinical variables and Thrombolysis in Myocardial Infarction（TIMI） Risk Score for unstable angina and non–ST-elevation myocardial infarction（UA/NSTEMI）.Methods：In 205 consecutive patients with UA/NSTEMI,we retrospectively evaluated admission ECG for aVR（＋） more than 0.5 mm.Results：With the use of multivariate analysis,admission aVR（＋） was found to be a strong and independent predictor of 30 d mortality rate.The mortality rate was also increased with the severity of aVR（＋）.In the low-risk groups by clinical factors,those with aVR（＋） had higher death rate than those without aVR（＋） for the patients with negative troponin,heart rate of 110 beats per minute or less,systolic blood pressure greater than 90 mmHg,Killip I class on admission,and aged 70 years or younger,respectively.Compared with the patients without aVR（＋）,the patients with aVR（＋）had higher death rates in the low-and intermediate-risk groups by TIMI risk score.Conclusion：aVR（＋） has important value to the patients with UA/NSTEMI and may provide an additional value to the risk stratification and prognosis,particularly in the patients in the low-risk and intermediate-risk groups.

关 键 词：AVR导联 急性冠脉综合征 危险分层 

分 类 号：R54[医药卫生—心血管疾病]