心电图在右冠状动脉急性闭塞部位判断中的价值探讨  

Value of electrocardiogram （ECG） in identifying acute occlusion sites of right coronary artery

作　　者：黄春林[1] 潘宜智[2] 

机构地区：[1]广州市第一人民医院心血管内科,510000 [2]江西省赣州市信丰县人民医院心内科

出　　处：《中华全科医师杂志》2015年第7期545-548,共4页Chinese Journal of General Practitioners

摘　　要：回顾分析151例右冠状动脉急性闭塞患者的临床资料，根据冠状动脉造影结果分为右冠近中段组和右冠远段组，对其心电图进行分析，探讨心电图改变用于判断右冠状动脉闭塞部位的方法和流程。结果显示，可用于判断右冠状动脉近中段闭塞的心电图指标有：V4R导联ST段抬高≥0．05mV，Ⅲ度房室传导阻滞，I导联ST段压低〉0．1mV，aVL导联ST段抬高≥0．2mV，Ⅲ导联ST段抬高〉0．25mV，V2-V4导联ST段压低之和≥0．4mV，I、aVL导联sT段压低之和I〉0．25mV；其中I导联ST压低〉0．1mV、V4R导联ST抬高≥0．05mV和Ⅲ度房室传导阻滞3个指标判断右冠脉近中段为梗死相关动脉的特异性均达100％。可用于判断右冠状动脉远段闭塞的心电图指标有：I导联ST压低≤0．1mV，aVL导联ST段压低〈0．2mV，Ⅲ导联ST抬高≤0．25mV，V2-V4导联sT压低之和〈0．4mV，V1～V5导联ST段均无下降，I、aVL导联ST压低之和〈0．25mV。并可根据4步流程法采用心电图判断右冠状动脉闭塞血管部位。提示在右冠状动脉急性闭塞病例中，应用心电图的特征和诊断流程可协助准确、快速地判断右冠状动脉近中段和远段闭塞部位。Clinical data of 151 patients with acute occlusion of right coronary artery were retrospectively analyzed. Coronary angiography and electrocardiography （EEG） were performed in all 151 patients, angiography showed proximal-middle segment occlusion in 114 cases and distant segment occlusion in 37 cases. The correlation of ECG findings with coronary artery occlusion sites was analyzed. Results showed that EEG findings related to proximal-middle segment occlusion were： ST segment elevation in lead V4RR≥0.05 mV, Ⅲ degree atfioventficular block, ST segment depression in lead I 〉0.1 mV, ST segment depression in lead AVL≥0.2 mV, ST segment elevation in lead Ⅲ≥0.25 mV, the total ST depression in lead V2, V3 and V4 I〉0.4 mV , the total ST depression in lead I and aVL ≥0.25 mV; among which ST depression of Lead I 〉0.1 mV, ST elevation of Lead V4R ≥0.05 mV and m degree atrioventricular block were used to predict occlusion of proximal-middle segment of fight coronary artery with 100% specificity. ECG findings related to distal segment occlusion were： ST depression in lead I ≤ 0. 1 mV, ST segment depression in lead AVL 〈0.2 mV, ST elevation in lead Ⅲ ≤0.25 mV, the total ST depression in lead V2, V3 and V4 〈0.4 mV, ST segment were not depression in lead V1 - V5 , the total ST depression in lead I and aVL 〈 0.25 mV. Based on a 4-step flow method, ECG might be adopted to identify the acute occlusion sites in proximal-middle segment and distal segment of fight coronary.

关 键 词：冠状动脉闭塞 下壁心肌梗塞 心电描记术 

分 类 号：R542.22[医药卫生—心血管疾病]