急性下壁心肌梗死相关动脉的心电图表现

Electrocardiographic analysis of infarction-related artery in acute inferior myocardial infarction

目的 对急性下壁心肌梗死患者入院时心电图与冠脉造影对照以探讨梗死相关动脉(IRA)与心电图关系。方法 对94例急性下壁心肌梗死患者入院心电图进行回顾分析,所有病人于发病3周内行冠脉造影检查,将病人分为两组。结果78例IRA为无左旋支(LCX)狭窄的右冠状动脉(RCA)病变组。ST_Ⅲ段抬高>ST_Ⅱ在RCA组56例(71.7％)而16例无RCA狭窄的LCK病变组无1例(0％);ST_(aVL)段压低>ST_1压低,RCA组54例(69％)、LCX组2例(12.5％);ST_(V1V2)段压低LCX组14例(88％),RCA组14列(18％);RCA组ST_(V7-V9)段抬高4例(5％),LCX组12例(75％);RCA组ST_(V3R-5R)抬高36例(46％),而LCX无1例(0％)。它们之间P值均少于0.001,有非常显著差异性。结论ST_Ⅲ段抬高>ST_Ⅱ、ST_(aVL)压低>ST_Ⅰ、ST_(V1-V2)压低及V(7-9)和V_(3R-5R)ST段抬高对急性下壁心梗时IRA对临床有一定价值。

Objective To discover a method of identifying infarction-related artery (IRA) based on electrocardiograms by exploring the relation between electrocardiograms and the distribution of coronary arteries of patients with acute inferior myocardial infarction. Methods Electrocardiograms on admission to hospital and coronary angiographies within 3 weeks from the admission of 94 patients with acute inferior myocardial were studied. These patients were divided into two groups based on their coronary angiographies the RCA group with right coronary arteries (RCA) as IRA and the LCX group with left circumflex arteries as IRA. There are 78 patients with no LCX stenosis in RCA group and 16 with no RCA stenosis in LCX group. Results ①56 patients (71.7%) with STⅢ segment elevation > STⅡ segment elevation in RCAgroup and none (0%) in LCX group were observed. ②54 patients (69% ) with STaVL depression > STI in RCA group and 2(12.5%) in LCX group were observed. ③ 14 patients (18%) with STv1-v2 segment depression in RCA group and 14(88%) in LCX group were observed. ④14 patients (88%) with ST segment V7-9 elevation in RCA group and 12(75%) in LCX group were observed. ⑤36 patients (40%) with ST segment elevation in V3R-5R and none in LCX group were observed. The differences between two groups are significant (P < 0.001) in the above 5 observations. Conclusion We suggested that STⅢ elevation > STⅡ, STaVL depression > STI, STv1-v2 depression, ST elevation V7-9 and V3R-5R may be of diagnostic Value in identifying IRA in acute inferior myocardial infarction.