急性下壁心肌梗死病人发生窦性心动过缓预测右冠状动脉闭塞的临床价值  

Clinical valve of sinus bradycardial in patients with acute inferior myocardial infarction

作　　者：赵茹[1] 田青平[1] 吴建国[1] 梁爽霖[1] 

机构地区：[1]天津市胸科医院,天津300051

出　　处：《中国心血管杂志》2000年第2期85-87,共3页Chinese Journal of Cardiovascular Medicine

摘　　要：目的 右冠状动脉闭塞或回旋支闭塞在临床心电图上均表现为急性下壁心肌梗死,二者鉴别较困难.本文观察和比较急性下壁梗死患者中发生窦性心动过缓与右冠状动脉闭塞的关系.方法 对52例急性下壁心肌梗死患者,观察其心率、血压、房室传导阻滞的发生情况.结果52例患者中,36例为右冠状动脉闭塞,16例为回旋支闭塞.单纯下壁心肌梗死,右冠状动脉较回旋支闭塞发生率高,分别为55.6%和18.8%(P<0.05).右冠状动脉闭塞发生低血压8例(22.2%);窦性心动过缓在右冠状动脉闭塞和回旋支闭塞发生率分别为25.0%和0%(P<0.05);完全性房室传导阻滞仅出现在右冠状动脉闭塞时共7例(19.4%);右冠状动脉近端闭塞较中、远端闭塞发生心率缓慢为多,分别为19.4%,2.8%,2.8%(P<0.05).结论 急性下壁心肌梗死时,窦性心动过缓与右冠状动脉闭塞有较好的相关性,右冠状动脉近端闭塞伴有缓慢心率,而回旋支闭塞几乎未发现窦性心动过缓.Objection Differentiation of right coronary artery (RCA) from left circuflex artery (LCX) occlusion may be difficult since both can present an electrocardiagraphic pattern of inferior myocardial infarction. The aim of this study was to analyze the relationship between sinus bradycardia and right coronary artery occlusion in patients with acute inferior myocardial infarction. Methods Fifty-two patients with inferior myocardial infarction (IMI) were studied, the changes of heart rate was observed continually and was compared with the results of coronary angiog-raphy. Results 36 patients with RCA occlusion and 16 patients with LCX occlusion. Patients with RCA occlusion had a higher incidence of isolated IMI than patients with LCX occlusion, 55. 6% vs 18. 8%, respectively (P<0. 05) . Arterial hypotension was more prevalent (P<0. 05) among patients with RCA (22. 2%) rather than those with LCX occlusion (0. 0%). RCA occlusion presented an association with sinus bradycardia, an association not with LCX occlusion (16. 7% vs 0. 0%, respectively, P<0. 05). Total atrioventricular block was only present a-mong patients with RCA (19. 7%). Proximal occlusion of the RCA presented lower heart rates (sinus bradycardia) than medial and distal occlusions (16. 7% vs 2. 8% and 2. 8% , respectively ;P<0. 05, and P<0. 05). Conclusion Sinus bradycardia is more frequent when the infarct-related artery is the RCA; proximal occlusions of the right coronary predispose low heart rates; and occlusion of the LCX rarely induces sinus bradycardia.

关 键 词：下壁心肌梗死 窦性心动过缓 心率 心电描记术 鉴别诊断 

分 类 号：R542.22[医药卫生—心血管疾病] R541.72[医药卫生—内科学]