急性非ST段抬高型心肌梗死患者梗死相关动脉为左回旋支的心电图特征  

Electrocardiographic Characteristics of Left Circumflex as Infarct-related Artery in Acute Non-ST Segment Elevation Myocardial Infarction Patients

作　　者：郑文成 昃峰[1] 

机构地区：[1]北京大学人民医院心内科,北京100044 [2]唐山市工人医院心内科,唐山063000

出　　处：《中国循环杂志》2023年第4期408-413,共6页Chinese Circulation Journal

摘　　要：目的:分析急性非ST段抬高型心肌梗死(NSTEMI)患者梗死相关动脉(IRA)为左回旋支的心电图特征并总结规律,以帮助临床医师早期识别这类患者,避免误诊而延误再灌注治疗时机。方法:回顾性分析2018年1月至2019年1月北京大学人民医院心内科收治的、冠状动脉造影显示IRA为左回旋支且无其他冠状动脉严重狭窄病变的患者108例,分析患者入急诊室后心电图各导联ST段及T波的改变情况。结果:108例患者平均年龄为(68.3±15.7)岁,男性70例(64.8%),从发病至获得首份心电图的平均时间为(185±90)min。60例(55.6%)患者接受急诊经皮冠状动脉介入治疗,平均入门(进入急诊室)至球囊扩张(DTB)时间为(108±23)min,其中15例(25.0%)患者DTB时间≤90 min。108例患者的心电图表现如下:(1)胸前导联:100例(92.6%)患者V_(1)导联T波直立且V_(1)导联T波振幅大于V_(6)导联T波振幅,96例(88.9%)患者V_(1)导联和(或)V_(2)导联R波/S波振幅≥1,96例(88.9%)患者V_(5)~V_(6)导联ST段压低>0.05 mV,仅16例(14.8%)患者V_(5)~V_(6)导联T波倒置;(2)肢体导联:103例(95.4%)患者Ⅰ、aVL导联T波倒置,仅23例(21.3%)患者Ⅰ、aVL导联ST段压低>0.05 mV。根据冠状动脉优势型区分,左优势型、右优势型、均衡型患者的心电图表现相似。在左回旋支不同节段(近段、远段、钝缘支)闭塞患者中,心电图表现也相似。结论:NSTEMI患者心电图如出现V_(1)导联T波直立且V_(1)导联T波振幅大于V_(6)导联T波振幅,同时V_(1)导联和(或)V_(2)导联R波/S波振幅≥1、V_(5)~V_(6)导联ST段压低,Ⅰ、aVL导联T波倒置,提示IRA很可能为左回旋支。Objectives:To analyze the electrocardiography(ECG)characteristics of acute non-ST segment elevation myocardial infarction(NSTEMI)in which the infarct related artery(IRA)is left circumflex,and summarize ECG features,in order to provide a theoretical basis for clinicians to early identify left circumflex related NSTEMI,avoid misdiagnosis and ensure timely reperfusion.Methods:This retrospective analysis included 108 patients who were admitted to the Cardiology Department of Peking University People’s Hospital from January 2018 to January 2019,had left circumflex defined as IRA by coronary angiography,and had no severe stenosis in other coronary arteries.The changes of ST segment and T wave in each lead on ECGs obtained in the emergency department were analyzed.Results:The average age was(68.3±15.7)years,70 patients(64.8%)were male.The time from disease onset to the first ECG was(185±90)min.60 patients(55.6%)received emergency percutaneous coronary intervention.The time from door(entering the emergency room)to balloon dilation(DTB)was(108±23)min.The DTB time in 15 patients(25.0%)was≤90 min.ECG features were as follows:(1)Precordial leads:100 patients(92.6%)showed upright T wave in lead V_(1)(V_(1)T)and higher T wave amplitude in lead V_(1) than that in lead V_(6)(V_(1)T>V_(6)T),96 patients(88.9%)showed R/S≥1 in lead V_(1) and/or V_(2),96 patients(88.9%)had ST segment depression in leads V_(5)-V_(6)>0.05 mV,and only 16 patients(14.8%)had T wave inversion in leads V_(5)-V_(6);(2)Limb leads:103 patients(95.4%)had T wave inversion in leadsⅠand aVL,and only 23 patients(21.3%)had ST segment depression>0.05 mV in leadsⅠand aVL.There was no significant difference in ECG features among left dominant,right dominant,and balanced patients.There was no significant difference in ECG manifestations among patients with different segments of the left circumflex(proximal,distal and obtuse marginal branches)as IRA.Conclusions:IRA is probably the left circumflex if the ECG of NSTEMI patients shows that V_(1)T is upright and

关 键 词：急性非ST段抬高型心肌梗死 梗死相关动脉 左回旋支 心电图 

分 类 号：R54[医药卫生—心血管疾病]