高侧壁、下壁导联ST段变化预测前降支阻塞部位的研究  

A Contrast Study for Electrocardiogram in Anterior Wall Acute Myocardial Infarction with High Lateral and Inferior Leads ST-segment Changes in Predicting of Occlusion Site in Left Anterior Descending Coronary Artery Angiography

作　　者：黄贵奇[1] 李德栋[1] 罗理宁 王俊谊[1] 颜程光[1] 

机构地区：[1]井冈山大学附属医院,江西吉安343000 [2]江西省吉安县中医院

出　　处：《中国医学创新》2015年第23期10-13,共4页Medical Innovation of China

基　　金：吉安市2011年度指导性科技计划项目(吉市科技字[2011]32号)

摘　　要：目的:探讨前壁急性心肌梗死(AMI)伴高侧壁、下壁导联ST段变化预测左前降支(LAD)阻塞部位的准确率。方法:选取2010年6月-2013年12月井冈山大学附属医院心血管科145例前壁AMI患者伴高侧壁、下壁导联ST段变化辅助预测LAD阻塞部位与冠状动脉造影术(CAG)显示阻塞部位进行对比分析,以大对角支(LD)或第1对角支(D1)为界划分LAD为近、远段。结果:145例前壁AMI患者中40例(27.59%)STⅠ、a VL抬高>0.1 m V,42例(28.97%)STⅡ、Ⅲ、a VF压低≥0.1 m V。STⅠ、a VL抬高>0.1 m V判断阻塞部位在LAD之D1或LD开口近段的敏感性(54.90%vs 52.17%,P=0.757)、特异性(87.24%vs 94.74%,P=0.096),两者比较差异均无统计学意义(P>0.05);阳性预测值[70.0%(28/40)vs 90.0%(36/40),P=0.025]比较差异有统计学意义(P<0.05);以LD为界时LAD近段闭塞有较高的阳性预测值。STⅡ、Ⅲ、a VF下移≥0.1 m V判断阻塞部位在LAD之D1或LD近段的敏感性(58.82%vs 56.52%),两者比较差异无统计学意义(P=0.801);特异性(87.24%vs 96.06%,P=0.044)、阳性预测值[71.43%(30/42)vs 92.86%(39/42),P=0.010],两者比较差异均有统计学意义(P<0.05),以LD为界时LAD近段闭塞有较高的特异性及阳性预测值。结论:高侧壁、下壁导联ST段变化对前降支阻塞部位的预测有重要的辅助作用。Objective： To explore the accuracy for electrocardiogram （ ECG ） prediction of left anterior descending artery （LAD） occlusion site in the anterior wall acute myocardial infarction （AMI）with high lateral and inferior leads ST-segment changes.Method： 145 patients with anterior wall AMI were selected in our hospital from June 2010 to December 2013.The ECG with high lateral and inferior leads ST-segment changes predicted the occlusion sites were compared with CAG showed in the cardiovascular departmentThe left anterior descending artery was divided into proximal and distal segment by the large diagonal （ LD ） or the first diagonal （ D 1 ） .Result： In 145 patients of anterior wall AMI, 40 cases （ 27.59% ） with ST I, .vt elevation〉0.1 mV, 42 cases （ 28.97% ） with ST G, 11I. ,vF depression I〉 0.1 mV.ST t. ,vL elevation〉O.1 mV judged the occlusion site in the recent opening of D1 or LD of the LAD, compared the two indexes of sensitivity （ 54.9% vs 52.17%, P---0.757 ）and specificity （ 87.24% vs 94.74%, P--0.096 ）of them, the differences were no statistically signifieant（ P〉0.05 ）;in the positive predictive value of them [70.0%（ 28/40 ）vs 90.0%（ 36/40 ）], the difference was statistically significant （ P=0.025 ）, so as the LD boundary proximal LAD occlusion had a higher positive predictive value.ST 11. m. ,w depression 〉~ 0.1 mV judged the occlusion site in the recent opening of D1 or LD of the LAD, in the sensitivity of them （ 58.82% vs 56.52% ）, the differenee was no statistically significant （ P=0.801 ）, in the specificity （ 87.24% vs 96.06%, P=0.044 ） and positive predictive value [71.43%（ 30/42 ） vs 92.86%（ 39/42 ）, P=O.010] of them,the differenees were statistically significant（ P〈0.05 ）, so as the LD boundary proximal LAD occlusion had higher specificity and positive predictive value.Conclusion： An important supporting role is played in predietion of LAD occlusion site in the anterior wall AMI with high lateral and inferi

关 键 词：左冠状动脉前降支动脉 前壁急性心肌梗死 心电图 冠状动脉造影术 

分 类 号：R542.22[医药卫生—心血管疾病]