下壁心肌梗死Rvs振幅降低及R_(v4)/R_(v5)比值对合并后壁心肌梗死定位诊断及梗死相关动脉研究

Study on below myocardial infarction with R_(v5) descend and R_(v4)/R_(v5) diagnose of the posterior myocardial infarction

目的探讨Rv5较Rv4波幅降低幅度和Rv4/Rv5比值指标,分析下壁合并后壁心肌梗死诊断价值及梗死病变动脉相关性。方法下后壁MI 270例（急性176例,陈旧性94例）,单纯下壁MI 408例,健康人100例,均查同步12导联ECG,确定Rv4较Rv5波幅降低≥0.5mV及Rv4/Rv5≥1.5,对MI不同病程及冠脉造影相关动脉综合分析。结果Rv4波幅各组间差异无统计学意义（P〉0.05）,下后壁组Rv5降低0.40-0.49mV7例（2.6%）,≥0.5mV263例（97.3%）。Rv4/Rv5≥1.5,急性期与陈旧性差异无统计学意义（P〉0.05）,但高于下壁和健康组（P〈0.01）,诊断后壁MI敏感性97.1%,特异性82.9%,准确度90.4%,阳性预测值94.4%,冠脉造影右冠脉病变为主,双支、三支病变多见（P〈0.01）。结论Rv5振幅较Rv4降低≥0.5mV,Rv4/Rv5≥1.5与下后壁MI定位、病变范围累及梗死冠脉有关而与病程及时程无关。Rv5波幅降低越明显,Rv4/Rv5比值越大,对下壁合并后壁MI诊断率越高,为临床治疗STEAMI PCI和冠脉造影,开通梗死相关动脉提供依据。

Objective To study diagnose with the below myocardial（BMI）on Rv5 descend and Rv4/Rv5 vatic of the posterior MI. Methods 270 cases of the BMI merge into PMI （AMI） 176 cases and 94 cases of QMI. 408 cases of the BMI. 216 cases of normal 12 lead ECG on Rv5 in comparison with Rv4 lower and Rv4/Rv5 ≥1.5,11 cases coronary artery form reflection of BMI. Results Rv4 amplitude a Bout the same similar of between every group （P〈0.05）. The BMI in 6 cases Rv5 amplitude lower 0.4-0.49 mV （2.6%） and ≥0. 5 mV of 203 cases （97.1%）. AMI and QMI of Rv5 in comparison with Rv4 lower ≥0. 5 mV and Rv4/Rv5 〉11.5 （P〉0. 05 ） into the susceptibility 97.1% ,the excellent 82. 9% ,the accurate 90.4% ,the positive 94.4% comparison with below and normal group high （P 〈 0. 01 ）. Conclusion Rv5 compored with Rv4 lower≥0. 5 mV and Rv4/ Rv5 ≥1.5 of the fixed position to do with scope and have nothing to do with course disease BPMI. Rv5 amplitude with the more over, Rv4/Rv5 the more ratio of diagnose rate the more of BPMI. Coronary artery radiography prompts where two and three most raise of coronary armory cabalism.