急性下壁心梗伴不同aVR导联ST段改变的临床特点

Clinical Characteristics of Patients with ST-segment Elevation in Acute Inferior Wall Myocardial Infarction Accompanied by Different ST-segment Deviation in Lead aVR .

【目的】探讨ST段抬高急性下壁心肌梗死(心梗)伴不同aVR导联ST段改变患者的心电图特点、梗死面积及心功能情况。【方法】110例急性下壁心梗患者根据入院时心电图aVR导联ST段改变情况将患者分为3组:A组为aVR导联ST段均不压低;B组为aVR导联ST段压低<0.1mV;C组为aVR导联ST段压低≥0.1mV【结果】胸痛发作到入院时间三组患者差别无显著性;心肌酶学CK最大值A组最低,C组最高[A组:(1380±531)IU/L,B组(1834±920)IU/L,C组(2177±1120)IU/L](P<0.01);左室射血分数A组最高,C组最低[A组:(55.8%±8.7%);B组:(46.9%±6.9%);C组:(40.5%±7.8%)](P<0.01);住院期间发生充血性心衰比率(A组:4.0%;B组11.8%;C组28.0%)(P<0.01)和入院时心率[A组:(66±17)次/min;B组:(70±18)次/min;C组:(75±20)次/min](P<0.01)A组最低,C组最高。【结论】在急性下壁心梗的患者中aVR导联ST段压低的患者有更大的心梗面积和更差的心功能,可能意味着存在心尖部和正后壁透壁性心梗。

[Objective]To evaluate the clinical characteristics of different leads aVR ST-segment deviation on the initial electrocardiogram in patients with ST-segment elevation in acute inferior wall myocardial infarction. [Methods] The clinical characteristics of 110 patients with ST-segment elevation in acute inferior wall myocardial infarction were prospectively analyzed and they were divided into three groups： group A, 51 patients with no ST-segment depression in lead aVR; group B, 34 patients with ST-segment depression in lead aVR 〈 0. 1 mV; and group C, 25 patients with ST-segment depression in lead aVR≥0.1 mV. [Results]There were no differences in time from symptom onset to hospital admission among the three groups, Peak ereatine kinase level was lowest in group A and highest in group C. Left ventrieular eject fraction was lowest in group C and highest in group A, Congestive heart failure during hospitalization and heart rates on hospital admission were lowest in group A and highest in group C[Conelusion]ST-segment depression in lead aVR is associated with a large infarct size and a poor LA function in patients with ST-segment elevation in acute inferior wall myocardial infarction, at the same time it might be a reciprocal change resulting from ST-segment elevation in the apical and inferolateral walls infarction.