急性前壁心肌梗死患者心电图下壁导联改变的意义  

Implications of inferior ST-segment deviation in patients with anterior wall acute myocardial infarction

作　　者：王兴祥[1] 冯义柏[1] 周利龙[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院心内科暨心血管病研究所,武汉430022

出　　处：《中国综合临床》2002年第1期18-19,共2页Clinical Medicine of China

基　　金：湖北省"九五"重点攻关项目基金资助No:96 2 P110 1

摘　　要：目的明确常规体表心电图下壁导联 ST段偏移对急性前壁心肌梗死患者左冠状动脉前降支 ( LAD)分布特点及其病变部位的判断价值。方法根据 L AD分布特点及其病变部位在第一对角支或第一间隔支的近端抑或远端 ,将 87例急性前壁心肌梗死患者进行分组 ,并比较各组患者的心电图改变。结果 1L AD近端病变组患者下壁导联 、 和 a VF的 ST段压低≥ 1mm的发生率明显高于远端组患者 ( :79%与 2 9% , :86 %与 19% ,a VF:75 %与 45 % ,P<0 .0 1) ;2左冠优势型组患者下壁导联 、 和 a VF的 ST段压低≥1mm的发生率明显优于非优势型组患者 ( :2 8%与 92 % , :2 8%与 94% ,a VF:31%与 96 % ,P<0 .0 1) ;3共 12例患者下壁导联ST段抬高总和≥ 3.0 mm,且均见于左冠优势型并 LAD远端病变患者。结论常规体表心电图下壁导联 ST段偏移是判断Objective To test the evaluation of inferior ST segment deviation to distribution of left anterior descending branch of coronary artery (LDA) and its lesion site in the patients with anterior wall acute myocardial infarction (AMI).Methods 87 patients with anterior wall AMI were divided into groups based on LDA distribution features and lesion proximal or distal to the first septal or to the diagonal branch.The changes of ECG were compared.Results ①The incidence of ST segment depression≥1 mm in leads Ⅱ,Ⅲ and aVF was significantly higher in the patients with LAD artery lesion proximal to the first septal or diagonal branch than that in the patients with LAD artery lesion distal to the first septal and diagnonal branch (Ⅱ:79% vs 29%,Ⅲ:86% vs 19%,aVF: 75% vs 45%,P<0.01);②The incidence of ST segment depression≥1 mm in leads Ⅱ,Ⅲ and aVF was significantly lower in the patients with a wraparound LAD than that in the patients with short LAD (Ⅱ:28% vs 92%,Ⅲ:28% vs 94%,aVF:31% vs 96%, P< 0.001);③Total inferior ST segment elevation in leads Ⅱ,Ⅲ and aVF≥3.0 mm was seen in 12 patients and all had a wraparound LAD with a lesion distal to the first septal and diagonal branches.Conclusion ST segment deviation is a good way to evaluate the distribution of LAD and its lesion site.

关 键 词：急性心肌梗死 心电图 ST段偏移 

分 类 号：R542.22[医药卫生—心血管疾病]