常规导联与头胸导联对急性下壁心肌梗死心电图定位诊断的比较

Comparison between head-chest lead electrocardiogram and routine lead electrocardiogram in diagnosis of patients with acute inferior myocardial infarction

目的:观察急性下壁心肌梗死心电图定位诊断方面,头胸导联是否具有与常规导联一样的价值.方法:对于正常人和经冠状动脉造影确诊的急性下壁心肌梗死患者,同步记录常规导联心电图和头胸导联心电图各一份,由两位不知情的资深电生理医生进行分析诊断.而后由观察者将两种体表心电图的诊断结果与冠脉造影的结果、以及正常人的结果相对照,分别计算出两种导联系统对急性下壁心肌梗死心电图诊断的准确率和假阳性率,并作χ2检验进行比较.结果:本实验包括由全国十二家大医院提供的急性下壁心肌梗死患者48例和正常人52例.常规导联心电图对急性下壁心肌梗死的诊断准确率为93.7%(42/48)、假阳性率为19.2%(10/52);而头胸导联心电图的诊断准确率为97.9%(44/48)、假阳性率为0(0/52).头胸导联诊断急性下壁心肌梗死的准确率高于常规导联,但无统计学差异(P>0.05);假阳性率低于常规导联,且有统计学差异(P<0.05).结论:在对急性下壁心肌梗死的定位诊断方面,头胸导联以其较低的假阳性率而优于常规导联.

AIM： To observe whether there was difference between the head-chest leads electrocardiogram （HCECG） and the routine leads electrocardiogram （RLECG） in diagnosis of patients with acute inferior myocardial infarction （AIMI）. METHODS： HCECG and RLECG were recorded simultaneously in 52 normal persons and 48 patients with AIMI, which had been confirmed by coronary angiography. Each HCECG and RLECG was analyzed by the same senior physician in clinical electrophysiology who was blind for the results. Then the diagnostic results of the HCECG and RLECG were compared with the true checking results. The accuraly rate and the false positivity rate of the HCECG and RLECG were calculatd. And the chi-square test was performed to observe if there was statistical difference between the HCECG and RLECG in diagnosis of patients with AIMI. RESULTS： The accuracy rate in diagnosis of AIMI was 93.7% （42/48）in RLECG, and 97.9% （ 44/48 ） in HCECG. There was no statistical difference between them （ P 〉 0.05 ）. However, the false positivity rate in diagnosis of AIMI was 19.2% （10/52） in RLECG, and 0.070% （0/58） in HCECG. There was significant difference be- tween them （ P 〈 0.05 ）. CONCLUSION ： Head-chest lead system seems to be better than routine lead system in diagnosis of the patients with AIMI for its relative high specificity.