急性Q波下壁心肌梗死V_(1)、V_(2)导联ST段变化冠脉造影与临床分析

Coronary angiography and clinical analysis of ST_(V1、V2) change in Q-wave acute inferior myocardial infarction.

目的 结合冠脉造影探讨初发急性心肌梗死患者STV1、STV2 变化的临床意义。方法 63例急性下壁心肌梗死患者行冠脉造影及经皮冠状动脉腔内成形术 (PTCA) ,根据就诊时第一份心电图V1、V2 导联ST段抬高、无改变及压低情况分为A组 ( 6例 ,STV1抬高≥ 1 0mm、STV2 压低≥ 0 5mm) ;B组 ( 13例 ,STV1无改变、STV2 压低≥ 0 5mm) ;C组 ( 3 4例STV1及STV2 均压低≥ 0 5mm) ;D组 ( 13例 ,STV1及STV2 均无改变 )。四组之间进行心电图、临床指标及冠脉造影比较。结果 冠造发现A组及B组的罪犯血管 (除B组 1例为前降支近段闭塞外 )全部为右冠状动脉 ,两组患者近段血管病变 (RPL)发生率无明显差异 ( 83 %对 88% ,P >0 0 5 ) ,B组的RPL明显高于C、D两组 ( 2 5 %及 2 2 % ,P均 <0 0 5 )。A、B两组右室梗死 (RMI)发生率无区别 ( 66%与 70 % ,P >0 0 5 ) ,但B组RMI发生率明显高于C、D两组 ( 14%及 7% ,P均<0 0 5 )。A、B两组病人的低血压和 (或 )休克发生率无明显区别 (P >0 0 5 ) ,但明显高于C、D两组。A、B、C、D四组患者心律失常发生率均无明显差异 (P均 >0 0 5 )。结论 急性Q波下壁心肌梗死STV1无改变或抬高、STV2 压低者病情重 ,是右冠脉闭塞位置高 ,坏死范围广泛且有可能合并右室梗死的证据 ,而STV1。

Objective This study was designed to determine the clinical significance of ST segment change in the precordial leads(leads V 1 and V 2)in acute Q-wave inferior wall myocardial infarction.Methods 63 patients were allocated into four groups based on ST V1?V2 depression,elevation or no change (on the baseline).Group A consists of 6 patients with both elevation of ST V1≥1.0 mm and depression of ST V2;group B consists of 10 patients with no change in ST V1,whereas depression of V 2≥0.5mm;there were 34 patients in group C,with both ST V1 and ST V2 in the 13 patients of group D.All patients received coronary angiography and PTCA.Results The coronary angiography reveals that culprit vessels of group A and group B (except one patient in group B is proximal occlusion of descending anterior branch) is right coronary artery.No difference is found in the incidence of proximal vessel lesion in these two groups (83% vs 88%,P>0.05;nor is the incidence of right ventricular myocardial infarction (RMI) (66% vs 70%,P>0.05).But the incidence of group B was much higher than group C and D (14% and 7%,P<0.05).No difference is found in incidence of hypotension and/or shock in group A and B(P>0.05),but this incidence is higher than group C and D significantly.No difference is found in the odds of arrhythmia in these four groups (P>0.05).Conclusion In Q-wave acute inferior myocardial infarction,elevation or no change of ST V1 or depression of ST V2 is predictive of critical condition,it is the testimony of proximal occlusion of right coronary artery,extensive infarction,or perhaps accompanied by right ventricular infarction.Whereas the patient′s condition is comparatively stable with depression of no change in ST V1 and ST V2.