急诊冠脉造影分析急性心肌梗死时心电图的改变

Analysis on changes of electrocardiogram in acute myocardial infarction by emergency coronary angiograply

目的探讨急性心肌梗死时非梗死区心电图导联对应性ST段下移的临床意义。方法分析78例急性心肌梗死患者行急诊冠状动脉造影时所见的梗死相关动脉(IR A)和非梗死相关冠脉病变情况,对比术前急诊体表心电图的改变,分析非梗死区心电图ST段下移(≥0.1m V)与冠脉病变的关系。结果45例急性广泛前壁心肌梗死患者,IR A为前降支(LA D),其中29例合并右冠脉(R C A)或回旋支(LC X)狭窄病变,25例(25/29,86.2%)相应STⅡ、Ⅲ、avF下移;16例无合并R C A或LC X病变者,仅3例(3/16,18.8%)有相应STⅡ、Ⅲ、avF下移。33例急性下壁心肌梗死患者,IR A为R C A是30例,LC X3例,其中22例合并LAD狭窄病变,相应前胸导联下移者18例(18/22,81.8%),11例无合并LAD狭窄病变者,仅1例(1/11,9.1%)有相应前胸导联下移。结论在急性心肌梗死时,心电图上非梗死区ST段下移者,大部分合并IR A以外的血管狭窄病变,仅少数病例属纯电生理的“镜像”关系。

To explone the clinical significance of ST reciprocal depression in electrocardiogram(ECG) of the noninfaction are a of acute myocardial infarction. To analyze the pathology of infarction related artery and noninfarction artery by emergency coronary angiography in 78 cases with AMI, contrasted with the changes of ECG before the operation, and observed the relation of the ST depression(≥0.1mv)and the coronary pathology. 45 cases of acute anterior infarction, the IRA was LAD. Among them 29 cases with the stenosis of RCA or LCX, 25cases (25/29,86.2%) with ST depression in Ⅱ, Ⅲ, avF. 16 cases without pathology of RCA or LCX, only 3 cases (3/16,18.8%) with ST depression in Ⅱ, Ⅲ, avF. 33 cases of acute inferion or diaphragmatic infarction. the IRA of 30 was RCA, while 3 was LCX. Among them 22 cases with stenosis of LAD, of 18 cases (18/22 81.8%)with ST depression of chest leads (contionous four of V1 through V6). 11 cases without LAD stenosis, only 1 case (1/11 9.1%)with reciprocal ST depression. [Conclusions] In acute myocardial infarction, most cases with the ST depression of noninfarction area in ECG existed stenosis pathology beside IRA, only little cases belong to pure electrophysiological 'mirror image'.