急性前壁心肌梗死伴不同下壁导联ST段改变的临床特点分析  

Clinical analysis of difference of inferior ST segment change of acute anterior wall myocardial infarction

作　　者：王晓敏 宫本宏 

机构地区：[1]温州康宁医院心电图室,浙江省温州325007 [2]温州康宁医院心理科,浙江省温州325007

出　　处：《中国基层医药》2013年第21期3271-3273,共3页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的 探讨急性下壁心肌梗死（IAMI）伴不同下壁导联ST段改变的临床特点.方法 前瞻性分析2010年1月至2012年2月住院接受治疗的64例急性前壁心肌梗死患者的临床资料,将其按照入选时的心电图下壁导联ST段改变情况将其分为三组,其中A组（16例）下壁（Ⅱ、Ⅲ、aVF）中至少两个导联ST段抬高≥0.1 mV;B组（26例）下壁（Ⅱ、Ⅲ、aVF）中至少两个导联ST段压低；C组（22例）下壁（Ⅱ、Ⅲ、aVF）中仅一个导联或均无ST段改变；探讨急性前壁心梗伴不同下壁导联ST-T改变的梗死相关血管（IRCA）及梗死面积和心功能.结果 A、B、C三组IRCA均判断一致.对三组IRCA情况进行比较发现A组患者中以“绕过心尖的LAD”中远段为主,占81.25％；而B组26例患者均为非“绕过心尖的LAD”,其中非“绕过心尖的LAD”中近段18例,非“绕过心尖的LAD”中远段8例；C组22例患者中21为非“绕过心尖的LAD”,1例为“绕过心尖的LAD”中远段.A、B、C三组IRCA情况差异具有统计学意义（F=6.32、5.92、7.08、4.11,均P＜0.05）.结论 IRCA为LAD的急性前壁心梗时下壁ST段改变可能与LAD长度和病变部位有关,前壁AMI时下壁ST段的变化可以预测IRCA位置和LAD形态；与大多数的研究相一致.前壁合并下壁ST段同时抬高的患者若IRCA为“绕过心尖的LAD”,其梗死面积较小,心功能较好.Objective To investigate the clinical characteristics of inferior acute myocardial infarction （IAMI） with different inferior ST segment change.Methods The clinical data of 64 cases with acute anterior wall myocardial infarction from January 2010 to February 2012 in the hospital were prospectivly analyzed.According to wall leads ECG ST segment in the change situation,they were divided into three groups,group A （16 cases）,under the wall （]Ⅱ,Ⅲ,aVF） of at least two lead ST segment elevation ≥0.1mV,group B（26 cases） under the wall（Ⅱ,Ⅲ,aVF） of at least two lead ST segment depression,group C （22 cases） under the wall（Ⅱ,Ⅲ,aVF） only a lead or no ST segment change.The infarct related artery,acute anterior wall myocardial infarction with different inferior ST-T change （infarction related coronary artery,IRCA）,the infarct size and heart function were studied.Results IRCA in the three groups was consistent.The comparison of IRCA among the three groups showed that,A group of patients with “around the apical LAD” COSCO segment,accounting for 81.25％,and 26 cases in B group were not “around the apical LAD”,which was not “around the apical LAD” in 18 cases,8 cases of non-“ around the apex” COSCO LAD,of 22 patients in C group,21 cases non-“ around the apical LAD”,1 case was “around the apical LAD” COSCO,and the difference was statistically significant（F =6.32,5.92,7.08,4.11,all P ＜ 0.05）.Conclusion IRCA is the LAD of acute anterior wall myocardial infarction of inferior ST segment changes may be related with the length of LAD and the lesion site,changes of inferior ST segment of anterior wall AMI can predict the IRCA position and LAD morphology,consistent with most studies.Patients with anterior wall and inferior wall ST segment elevation if IRCA is “around the apical LAD”,the infarction area is smaller,better heart function.

关 键 词：心肌梗死 心电描记术 下壁导联ST段改变 临床特点 

分 类 号：R542.22[医药卫生—心血管疾病]