下壁心梗额面向量与冠脉罪犯血管的关系  

The relationship between inferior wall myocardial infarction and the culprit lesion of coronary artery

作　　者：赵熙璇 张维辛 王永权[2] 徐峰[2] 

机构地区：[1]江苏省中医院,210029 [2]中国医科大学附属第一医院,110001

出　　处：《临床心电学杂志》2016年第3期183-186,共4页Journal of Clinical Electrocardiology

摘　　要：目的本研究旨在分析急性下壁心肌梗死额面心室除极向量各参数的变化特点,探讨其与冠脉罪犯血管的关系,尤其是以ST向量角度的变化来区分冠脉病变部位位于右冠状动脉（RCA）或是左回旋支（LCX）,力求应用无创便捷的方法快速判断冠脉罪犯血管,为临床提供诊治参考。方法纳入中国医科大学附属第一医院心内科住院患者77例,临床诊断为急性下壁心肌梗死并行冠状动脉造影和/或行介入治疗者,证实病变血管为RCA或LCX,均于入院后48h内行床旁心电向量图检查。研究依据罪犯血管分为RCA、LCX两组,比较组间额面ST向量,起始向量的角度、振幅是否有统计学差异。结果急性下壁心肌梗死病变血管分组为RCA或LCX时,两组间额面ST向量方位构成比有统计学差异（χ~2=22.806,p=0.000）,其中LCX组额面ST向量方位以左下为主（组内构成比为63.64%）,RCA组额面ST向量方位以右下为主（组内构成比为69.09%）。以额面ST向量指向右下来判定罪犯血管为RCA的敏感度为69.09%,特异度为90.91%;以ST向量指向左下来判定病变血管为LCX的敏感度为63.64%,特异度为80.00%。对两组间额面QRS环最大向量和初始40ms内各10ms的振幅和角度进行比较,显示两组最大除极向量的振幅具有统计学差异（p=0.025）。结论急性下壁心肌梗死时,心电向量图中额面ST向量的方位对确定罪犯血管具有指导意义,其中ST向量指向左下多提示病变血管为左回旋支（LCX）,指向右下多提示病变血管为右冠状动脉（RCA）。Objective We try to explore the relationship between frontal plane ventricular depolarization vectors and site of culprit lesion of coronary artery in acute inferior wall myocardial infarction, especially to identify the RCA or LCX as the culprit lesion through the angle of ST-vector, thus we will make clinical diagnosis more efficiently.Method VCG was performed in 77 patients with acute inferior wall myocardial infarction within 48 h after being in hospital, and all patients were performed coronary angiography.Divide the patients into 2 groups which are RCA group and LCX group according to the outcome of coronary angiography, and then analyze the differences of ST-vector and the initial 40 ms vectors of frontal plane VCG QRS-loops in two groups. Results There are significant statistical difference between this two groups in ST-vector direction constituent ratio（χ~2=22.806,p=0.000）.In LCX group,frontal plane ST-vector mainly point to the lower left quadrant（constituent ratio is 63.64%）. In RCA group, frontal plane ST-vector mainly point to the lower right quadrant（constituent ratio is 69.09%）. Using ST-vector point to the lower left quadrant to identify the LCX, the sensitivity and specialty are 69.09% and 90.91%. using ST-vector point to the lower right quadrant to identify the RCA, the sensitivity and specialty are 63.64% and 80.00%. It reveals that the magnitude of maximum vector has statistical difference（p=0.025）between LCX and RCA group in inferior wall myocardial infarction. Conclusions he frontal ST-vector direction in vectorcardiogram has its profound guiding significance in identifying the culprit coronary lesion. If the ST-vector point to lower left quadrant, LCX may be the culprit vessel. Meanwhile, if the ST-vector point to lower right quadrant, RCA may be the culprit vessel.

关 键 词：心电向量图 急性下壁心肌梗死 冠脉罪犯血管 ST向量 

分 类 号：R542.22[医药卫生—心血管疾病]