下壁或下后壁心肌梗塞伴胸导ST降低的探讨

A Study on the ST segment Depressions in Chest Leads in IMI/IPMI Cases

右室梗塞（ＲＶＩ）常伴有急性左室下壁或下后壁的心肌梗塞（ＩＭＩ／ＩＰＭＩ），单独的ＲＶＩ少见，ＲＶＩ的心电图主要反映在ＳＴ（ｖ４Ｒ）抬高，有时常伸延至Ｖ６Ｒ甚至于到Ｖ９Ｒ，长期以来，下壁或下后壁心肌梗塞伴胸导ＳＴ降低被认为是下壁或下后壁梗塞后所产生的镜像反应，一直有争论。本文旨在探讨下壁或下后壁伴ＲＶＩ２２例患者中胸导ＳＴ（ｖ１，ｖ２）降低的１７例患者与同期下壁或下后壁心肌梗塞不伴ＲＶＩ６６例患者中胸导ＳＴ（ｖ１，ｖ２）降低的１３例患者相比，发现他们之间有明显的差异（Ｐ＜０．０１），从而，对下壁或下后壁心肌梗塞患者常规心电图ＳＴ（ｖ１，ｖ２）降低应高度怀疑伴有ＲＶＩ，及时检查、Ｖ３Ｒ～Ｖ６Ｒ，早期发现，及早治疗ＲＶＩ。

RVI seldom occurs alone,but often with acute IMI/IPMI.The signs of RVI on ECG are mainly reflected on the elevations of ST(v4R),sometimes extend to V6R.For a long time,ST depressions in chest leads in IMI/IPMI are regarded as image reflection after IMI/IPMI.The purpose of this paper is to demonstrate the obvious differences between the cases of the depressions of ST(v1,v2)from 22 cases of IMI/IPMI with RVI and the 13 IMI/IPMI cases of ST(v1,v2) from 66 cases of IMI/IPMI without RVI,and suggest that much attention be paid to such Cases,examination and treatment be done with no delay.