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胸前导联ST段压低范围和幅度在急性下壁心肌梗塞的意义 被引量:11

Clinical Implication of Precordial ST Depression in Patients with Acute Inferior Myocardial Infarction
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摘要 目的 :评价胸前导联 ST段压低对急性下壁心肌梗塞的临床意义及探讨其可能发生机理。  方法 :回顾分析了 1992年~ 1997年期间首次住院诊断急性下壁心肌梗塞患者 183例。将患者分为 4组 :无胸前导联ST段压低组 ( 组 ,n=5 6 ) ;胸前导联 ST段 V1~ 3压低组 ( 组 ,n=31) ;胸前导联 ST段 V4~ 6 压低组 ( 组 ,n=2 3) ;胸前导联 ST段 V1~ 6 压低组 ( 组 ,n=73)。资料分析包括心电图、心肌酶谱、左心室和冠状动脉造影及心肌梗塞的并发症和病死率。  结果 :胸前导联 ST段压低患者比无胸前导联 ST段压低患者存在较大梗塞范围 ,心肌梗塞并发症和住院病死率较高。广泛 ST段压低时更显著 ,其心律失常、心功能不全发生率和住院病死率分别为 45 .0 %、12 .3% (P<0 .0 5 )和 8.2 %(P<0 .0 1)。胸前导联 ST段广泛压低总和≥ 0 .8m V显示预后更差 ,住院病死率 9.4% ,同 ST段压低 <0 .2 m V比差异显著 (P<0 .0 5 )。 组和 组存在左前降支病变或合并多支冠状动脉病变明显高于 组 ,有统计学差异。  结论 :胸前导联 ST段压低分布范围和压低幅度对急性下壁心肌梗塞患者的预后判断和危险分层有一定价值。可能提示心肌梗塞范围较大 ,或同时存在前降支病变和多支冠状动脉病变。 Objective:To assess the clinical significane of precordial ST segment depression and discuss its praboble mechanism. Methods:One hundred and eighty three patients with acute inferior myocardial infarction were divided into four groups on the basis of admission electrocardiogram.Group Ⅰ:patients with no precordial ST segment depression ( n =56);Group Ⅱ:those with ST segment depression in leads V 1 to V 3 only( n =31);Group Ⅲ:those with ST segment depression in leads V 4 to V 6 only( n =23) and group Ⅳ:those with ST segment depression in leads V 1 to V 6( n =73).Clinical data including ECG,myocardial engzmes,coronary angiograms and left ventriculogram,postinfarction complications and hospital mortality rates were analyzed. Results:Patients with precordial ST segment depression in leads V 1 to V 6 had larger infarction size,more postinfarction complications and higher mortality rates than those without precordial ST segmemt depression (45 0% vs.26 8% in arrhythmias;12 3% vs.1 8% in congestive heart failure or shock;8 2% vs.0 in hospital mortality, p <0 05 or p <0 01).The patients with sum of leads V 1 to V 6 ST segment depression ≥0 8mV had more postinfarction complications and hospital mortality rates and may suggest lesion of the left anterior decending coronary artory or multivessel lesions. Conclusion:In patients with acute inferior myocadial infarction,the extent and magnitude of precodial ST segment depression is of clinical significace.Widespread (V 1 to V 6) ST depression may suggest lesion of the left anterior decending coronary artery or multivessel lesions.
出处 《中国循环杂志》 CSCD 北大核心 1999年第6期338-340,共3页 Chinese Circulation Journal
关键词 心肌梗塞 ST段压低 Myocardial infarction Procordial ST depression
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  • 1Lee K L,Circulation,1995年,91卷,1659页

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