体表心电图在急性下壁心肌梗死中的定位诊断价值  

Diagnostic value of the surface electrocardiogram in acute inferior myocardial infarction

作　　者：田江华[1,2] 卢广平[3] 张海澄[4] 田梦圆[5] 娄丽丽 Tian Jianghua;Lu Guangping;Zhang Haicheng;Tian Mengyuan;Lou Lili(Department of Internal Medicine, Peking University Hospital, Beijing 100871, China;Department of Emergency, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China;Department of Respiration, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052,China;Department of Cardiology, Peking University People s Hospital, Beijing 100044, China;Department of Pathlolgy, Henan Tumor Hospital, Zhengzhou 450008)

机构地区：[1]北京大学医院内科,100871 [2]北京大学人民医院 [3]郑州大学第一附属医院急诊科,450052 [4]北京大学人民医院心内科,100044 [5]河南肿瘤医院病理科,郑州450008 [6]郑州大学第一附属医院呼吸科,450052

出　　处：《中国心血管杂志》2018年第6期477-480,共4页Chinese Journal of Cardiovascular Medicine

摘　　要：目的探讨急性ST段抬高型下壁心肌梗死的体表心电图改变,及与罪犯血管的关系。方法回顾性分析2007—2009年北京大学人民医院收治的101例经冠状动脉造影证实的急性ST段抬高型下壁心肌梗死患者的体表心电图改变。结果 (1) ST段抬高Ⅲ/Ⅱ> 1者,其罪犯血管多为右冠状动脉(RCA),敏感度为78. 7%,特异度为85. 7%; ST段抬高Ⅲ/Ⅱ≤1者,其罪犯血管多为左冠状动脉回旋支(LCX),敏感度为72. 7%,特异度为89. 8%;(2)Ⅰa VL导联ST段下移多见于RCA闭塞,其敏感度为94. 8%,特异度为63. 6%,而Ⅰa VL无下移或抬高者多为LCX闭塞,其敏感度为70. 0%,特异度为95. 0%;(3) STV3下移/STⅢ升高,比值大于1. 2,闭塞部位多为LCX,在0. 5～1. 2之间,多为RCA远端,小于0. 5多为RCA近端,其敏感度分别为81. 8%、82. 3%和93. 8%,特异度分别为94. 1%、95. 2%和64. 1%。结论对于急性ST段抬高型下壁心肌梗死患者,体表心电图改变对罪犯血管有一定的定位诊断作用。Objective To investigate the relationship between electrocardiogram changes and culprit blood vessels in acute inferior myocardial infarction with ST segment elevation. Methods The surface electrocardiogram changes of 101 patients with acute inferior myocardial infarction confirmed by coronary angiography in the Peking University People s Hospital were retrospectively analyzed from 2007 to 2009. Results (1)When ST segment in lead Ⅲ/Ⅱwas more than 1, the most culprit blood vessels are mostly right coronary artery (RCA), sensitivity was 78.7%, and the specificity was 85.7%; When ST segment in lead Ⅲ/Ⅱ was less than or equal to 1, the most culprit blood vessels were left coronary artery circumflex (LCX) with a sensitivity of 72.7% and a specificity of 89.8%;(2)When leads Ⅰand aVL both had ST segments depression, there were more common in RCA occlusion, with a sensitivity of 94.8%, and specificity of 63.6%; but when the two leads without ST segment depression or with ST segment elevation, there was mostly LCX occlusion, and its sensitivity was 70.0%, and the specificity was 95.0%;(3) When STV3 moved down/STIII increased, the ratio was greater than 1.2, the occlusion site was mostly LCX, the sensitivity of was 81.8%, and specificity was 94.1%; when the ratio was between 0.5 and 1.2, mostly RCA distal, the sensitivity was 82.3%, and specificity was 95.2%; and when the ratio was less than 0.5, mostly RCA proximal, the sensitivity was 93.8%, and specificity was 64.1%. Conclusions For patients with ST segment elevation acute inferior myocardial infarction, the surface electrocardiogram changes have a certain diagnostic value in the location of culprit vessels.

关 键 词：急性心肌梗死 心电描记术 罪犯血管 

分 类 号：R542.22[医药卫生—心血管疾病]