心电图在右冠病变所致急性下壁心肌梗死时的预测价值  

Predictive value of electrocardiogram to acute inferior myocardial infarction induced by right coronary artery lesion

作　　者：梅志亮[1] 章志玲[1] 周淑兰[1] 

机构地区：[1]江西省人民医院,南昌330006

出　　处：《中国循证心血管医学杂志》2015年第2期251-252,共2页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的通过体表心电图探讨右冠状动脉(RCA)病变及判断RCA是否为优势血管对ST段抬高型急性下壁心肌梗死时的预测价值。方法对84例经冠状动脉造影证实RCA为梗死相关动脉患者的18导联心电图进行回顾性分析。结果 RCA近段病变的62例,RCA远段病变的22例。RCA近段病变患者中,STV4R抬高≥1 mm为56例,阳性率为90.3%,STV1-V2抬高≥2 mm的为52例,阳性率为83.9%。RCA远段病变的22例患者中,出现STV4R抬高≥1 mm的为0例,出现STV1-V2抬高≥2 mm的为1例,阳性率为4.5%。RCA优势型为56例,非RCA优势型为28例,RCA优势型的56例患者中,STV5-V6抬高≥1 mm为50例,阳性率为89.3%。非RCA优势型的28例患者中,STV5-V6抬高≥1 mm为0例。结论对于RCA病变所致ST段抬高型急性下壁心肌梗死患者,心电图STV4R抬高≥1 mm、STV1-V2抬高≥2 mm对RCA近段闭塞的识别有较大的价值,如同时合并有STV5-V6抬高≥1 mm,常提示患者为RCA优势型,其诊断的特异性、敏感性均较高。Objective To investigate lesion of right coronary artery （RCA） and judge whether RCA being dominant vessel and its predictive value to acute ST-segment elevation inferior myocardial infarction through analyzing surface electrocardiogram （ECG）.Methods The outcomes of 18-lead ECG were retrospectively analyzed in 84 patients after confirming RCA being related artery of inferior myocardial infarction.Results There were 62 patients with proximal lesion of RCA and 22 with distal lesion of RCA. Among patients with proximal lesion of RCA, there were 56 patients with STV4R elevation≥l mm （positive rate was 90.3%） and 52 with STV1-V2 elevation≥2 mm （positive rate was 83.9%）. Among patients with distal lesion of RCA, there was 0 patient with STV4R elevation≥l mm and 1 with STV1-V2 elevation≥2 mm （positive rate was 4.5%）. There were 56 patients with RCA-dominant infarction and 28 with non-RCA-dominant infarction. Among patients with RCA-dominant infarction, there were 50 with STV5-V6 elevation≥1 mm （positive rate was 89.3%）, and among patients with non-RCA-dominant infarction, there was 0 with STV5-V6 elevation≥1 mm.Conclusion To the patients with ST-segment elevation inferior myocardial infarction induced by lesion of RCA, STV4R elevation≥l mm and STV1-V2 elevation≥2 mm have great value to recognize proximal occlusion of RCA, and STV5-V6 elevation≥1 mm at the same time indicates that patients with RCA-dominant infarction, which has higher specificity and sensitivity in diagnosis.

关 键 词：急性下壁心肌梗死 右冠状动脉 心电图 预测价值 

分 类 号：R541.4[医药卫生—心血管疾病]