陈旧右心室梗塞期的右胸心电图研究

Study on Right Precordial Electrocardiogram in Old Right Ventricular Infarction

目的 探索陈旧左室下壁、右室梗塞患者右胸心电图特征及临床应用价值。方法 描记３４例临床确诊患者同时间、同部位的Ｗｉｌｓｏｎ导联（Ｖ３Ｒ－７Ｒ）和头胸（ＨＣ）导联（ＨＶ３Ｒ～７Ｒ）图形。结果 两种方法图形大致相仿、５３％及５９％的患者分别在Ｖ３Ｒ～７Ｒ和ＨＶ３Ｒ～７Ｒ导联均含病理Ｑ波、多数Ｔ波倒置或平坦，ＳＴ段基本无编移。约 ３５％和 １６％的患者分别在 Ｖ３Ｒ、 Ｖ４Ｒ和ＨＶ３Ｒ、ＨＶ４Ｒ出现 ｒ波。 ３４例患者 ＨＶ６Ｒ、ＨＶ７Ｒ病理 Ｑ波出现率达９７％，Ｔ波倒置或平坦达８０％。２４例（７１％）患者ＨＶ６Ｒ、ＨＶ７Ｒ的 ＱＲＳ—Ｔ波群形态酷似下壁导联 ａＶＦ。结论 ＨＣ导联的ＨＶ６Ｒ、ＨＶ７Ｒ病理Ｑ波有希望提供陈旧右室梗塞的线索。

Objective To study the clinical value of right precordial ECG during the old myocardial infarction in left ventricular inferior wall and right ven- tricle. Method 34 patients diagnosed in clinically were studied by Wilson leads (V3R to V7R ) comparing with HC leads (HV3R to HV7R). Results Two types ECG was similar. Fathological Q wave was found 53% in V3R to V7R, 59% in HV3R and companied with many negative or smooth T waves and ST segment was isoeledtric location. Small r wave was found 35 % in V3R,V4R and 16 % in HV3R,HV4R, However, pathological Q wave showed in HV6R, HV7R in 97% of all patients,negative or smooth T wave showed in 80%. QRS-T waves in HV6R and HV7R were similar to aVF lead of inferior wall in 24(71 % ) patients. Conclusions Pathological Q wave in HV6R and HV7R of HC lead could give a clue to diagnose the old right ventricular infarction.