回旋支不同节段闭塞致急性心肌梗死的心电图特征分析  

Diagnostic value of electrocardiogram in acute myocardial infarction associated with different circumflex branches

作　　者：孙莉莉[1] Sun Lili(Department of Electrocardiogram, the People's Hospital of Rugao, Rugao, Jiangsu 226500, China)

机构地区：[1]如皋市人民医院心电图室,江苏省226500

出　　处：《中国基层医药》2019年第9期1084-1087,共4页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨回旋支(circumflex artey,LCX)不同节段闭塞的体表心电图特点。方法分析2015年2月至2018年2月如皋市人民医院心内科收治的LCX闭塞致急性心肌梗死患者85例的心电图特征,以冠脉造影检查结果为准,受试者工作特征曲线(ROC)分析体表心电图诊断LXC闭塞急性心肌梗死的效能。结果右优势型LCX闭塞心电图改变以STⅡ、Ⅲ、AVF抬高为主(76.47%),均衡型以STV1~V3下移为主(68.00%),左优势型以STⅡ、Ⅲ、AVF抬高(88.89%)、STV7~V9抬高为主(66.67%),STV1~V3下移、STⅡ、Ⅲ、AVF抬高、STV7~V9抬高在不同冠脉分型中差异均有统计学意义(χ^2=4.028、4.061,均P<0.05)。远段、中段LCX闭塞心电图改变以STⅡ、Ⅲ、AVF抬高为主(100.00%、78.95%),近段、钝缘支以STV1~V3下移为主(88.24%),STV1~V3下移、STⅡ、Ⅲ、AVF抬高、STⅠ、aVL抬高、STV7~V9抬高在不同节段LCX闭塞心电图变化差异均有统计学意义(χ^2=6.024、5.318、4.971,均P<0.05)。STV1~V3下移、STⅡ、Ⅲ、AVF抬高诊断LCX闭塞急性心肌梗死敏感度、特异度、阳性预测值、阴性预测值、准确度、曲线下面积(AUC)分别为82.06%、92.63%、89.91%、86.34%、88.06%、0.830(95%CI:0.853~0.991);86.83%、95.37%、92.38%、88.61%、90.64%、0.922(95%CI:0.729~0.931),效能优于STⅠ、aVL抬高、STV7~V9抬高。结论LCX闭塞急性心肌梗死体表心电图受多种因素影响表现多样化,STV1~V3下移、STⅡ、Ⅲ、AVF抬高对LCX闭塞急性心肌梗死具有较高诊断价值,临床应结合病史和其他检查手段进行准确判断。Objective To investigate the characteristics of body surface electrocardiogram (ECG) of different segments of circumflex artey (LCX) occlusion. Methods The ECG characteristics of 85 patients with acute myocardial infarction caused by LCX occlusion in the People's Hospital of Rugao, Jiangsu, from February 2015 to February 2018 were analyzed.The results of coronary angiography were taken as the criteria.The efficacy of the body surface ECG for the diagnosis of LXC occlusion of acute myocardial infarction was analyzed by receiver operating characteristic curve (ROC). Results The ECG of right dominant LCX occlusion was dominated by STⅡ,Ⅲ, AVF elevation (76.47%), and the balance type was dominated by STV1-V3 (68%), and the dominant left dominant type was STⅡ,Ⅲ, AVF elevation (88.89%) and STV7-V9 elevation (66.67%). STV1-V3 moved down, STⅡ,Ⅲ, AVF elevation, STV7-V9 elevated in different coronary points.The differences between the two groups was statistically significant (χ^2=4.028, 4.061, all P<0.05). The ECG changes of LCX occluded in the distal and middle segments were dominated by STⅡ,Ⅲ, AVF (100%, 78.95%), and the proximal and blunt branches were dominated by STV1-V3 (88.24%). STV1-V3 moved down, STⅡ,Ⅲ, AVF elevation, STⅠ, aVL elevation and STV7-V9 elevation had statistically significant differences(χ^2=6.024, 5.318, 4.971, all P<0.05). The sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and area under the curve of STV1-V3, STⅡ,Ⅲ, AVF elevation were 82.06%, 92.63%, 89.91%, 86.34%, 88.06%, 0.830 (95%CI: 0.853-0.991), respectively, and 86.83%, 95.37%, 92.38%, 88.61%, 90.64%, 0.922 (95%CI: 0.729-0.931), respectively, the efficiency is better than STⅠ, aVL and STV7-V9. Conclusion The body surface ECG of LCX occlusive acute myocardial infarction is varied with various factors.STV1-V3 shift, STⅡ,Ⅲ, AVF elevation are of high diagnostic value for LCX occlusion of acute myocardial infarction, and the clinical history and other methods should be used

关 键 词：心肌梗塞 冠状动脉闭塞 心电描记术 回旋支 

分 类 号：R542.22[医药卫生—心血管疾病]