急性下壁心肌梗死冠状动脉造影与心电图的对比研究(附89例分析)

Contrastive study on coronary angiography and electrocardiogram in patients with acute inferior myocardial infarction

目的探讨急性下壁心肌梗死（AIMI）时体表心电图对梗死相关动脉（IRA）的判断价值。方法选择2004年1月-2007年12月急性下壁心梗患者89例，对其心电图Ⅱ、Ⅲ导联ST段抬高比值及I、AVL、V4R导联ST段偏移进行分析并与冠状动脉造影的结果比较。结果89例中，右冠状动脉（RCA）为IRA者67例（75.3％），左回旋支（LCX）22例（24.7％）；STⅢ／STⅡ抬高比值〉1，STaVL、ST1压低，STv4R抬高≥0.5mm，提示IRA为RCA；而STⅢ／STⅡ抬高比值≤1，STavL、ST1抬高，提示LCX为IRA。结论心电图中STⅢ／STⅡ抬高比值，STaVL、ST1及STv4R变化可作为AIMI患者IRA的临床判断指标。

Objective To investigate the diagnostic value of electrocardiogram （ECG） criteria for infarct-related artery （IRA） in acute inferior myocardial infarction （AIMI）. Methods We selected 89 patients from January 2004 to December 2007. We analyzed the ratio of STⅡ and STⅢ and the migration of ST1, STavL and STv4R in ECG, which compared to coronary angi-ography. Results The IRA of 67 patients were right coronary artery （RCA） and 22 （24.7%） patients were left circumflex artery （LCX）. ST-segment elevation in lead Ⅲ exceeding that in lead Ⅱ, ST-segment elevation ≥0.5 mm in lead V4R, ST-segment depression in lead AVL and lead I indicated that IRA were RCA. The contrary indicated that IRA were LCX. Conclusion ECG criteria such as the ratio of ST-segment elevation Ⅲ/Ⅱ, and the change of ST-segment in lead aVL, lead I and lead V4R can be used for identifying IRA in patients with AIMI.