急性前壁心肌梗死患者心电图aVR和aVL损伤图形的意义  

Significance of electrocardiogram injury pattern in aVR and aVL in patients with acute anterior myocardial infarction

作　　者：贾士杰[1] 王昭琴 吴学思[1] 吕树峥[1] 马临安[1] 

机构地区：[1]北京安贞医院心内科,100029 [2]山东省威海市环翠区人民医院内科

出　　处：《中国医刊》2003年第6期34-36,共3页Chinese Journal of Medicine

摘　　要：目的　探讨急性前壁心肌梗死患者心电图aVR和aVL导联损伤图形与临床预后的关系。方法　入选急性前壁 (包括前壁、广泛前壁、前壁 +侧壁 )心肌梗死患者 10 2例 ,分析入院当时心电图 ,aVR导联损伤图形指ST段抬高或压低≥0 0 5mV ;aVL导联损伤图形包括以下情况之一 :①ST段抬高≥ 0 0 5mV ;②ST段抬高幅度 <0 0 5mV同时伴有T波对称性倒置 ;③ST段在等电线而伴有T波对称性倒置和病理性Q波形成 (时间≥ 3 0ms)。所有患者于发病 2周行超声心动图并测量左室射血分数 (LVEF)。记录入院期间心脏事件情况。结果　①伴aVR导联损伤图形者CK、CK MB峰值明显增高。②伴aVL导联损伤图形者CK、CK MB峰值明显增高而LVEF明显减低。③同时伴aVR和aVL导联损伤图形者CK、CK MB峰值、左室收缩末期容积 (ESV)和室壁瘤发生率明显增高 ,而LVEF明显减低。Objective To observe the relationship between electrocardiogram injury pattern in aVR and aVL and clinical prognosis in patients with acute anterior myocardial infarction.Methods One hundred and two cases with anterior myocardial infarction who received thrombolytic therapy were selected.Electrocardiogram at admission were analyzed.ST segment elevation or depression ≥0.05mV in aVR lead were defined as aVR injury pattern.aVL injury pattern included any of the following criteria (1)ST elevation≥0.05mV;(2)any symmetrical T-wave inversion associated with less degree ST elevation;(3)any isoelectric ST segment associated with both symmetrical T-wave inversion and an abnormal Q wave(≥30ms in duration).Echocardiography were examined at 2 weeks and LVEF were measured in all patients.All cardiac events in hospital were recorded.Results (1)Peak value of CK and CK-MB were higher in patients with aVR injury pattern than without.(2)Peak value of CK and CK-MB were higher and LVEF were lower in patients with aVL injury pattern than without.(3)Peak value of CK,CK-MB,left ventricular end systolic volume (ESV),the incidence of left ventricle aneurysm were higher and LVEF were lower in patients with aVR and aVL injury pattern than without.Conclusion ECG aVR and aVL injury pattern in patients with acute anterior myocardial infarction were the important marker in predicting clinical prognosis.

关 键 词：急性前壁心肌梗死 心电图 AVR AVL 损伤图形 预后 ST段抬高 

分 类 号：R542.22[医药卫生—心血管疾病] R540.41[医药卫生—内科学]