aVR导联QRS波形态对下壁心肌梗死的鉴别诊断意义

The value of differential diagnosis of the configuration of QRS complex in lead aVR in patients with inferior wall myocardial infarction

目的探讨aVR导联QRS波形态对下壁心肌梗死的鉴别诊断意义。方法分析52例Ⅲ、aVF导联均为病理性Q渡患者的aVR导联QRS波形态，并与选择性冠状动脉造影结果对照。结果aVR导联QRs波呈rS（s）型、QS（qs）型和Q（q）r型的患者分别为13例、10例和29例，三种形态与冠状动脉造影结果比较显示右冠状动脉或左回旋支有狭窄、闭塞病变的患者分别为12例、4例和0例，差异有统计学意义（χ2=35．56，P=0．000）。结论aVR导联QRS波形态对Ⅲ、aVF导联均为病理性Q波患者具有鉴别诊断意义。aVR导联QRS波呈Q（q）r型，可排除陈旧性下壁心肌梗死；aVR导联QRS波呈rS（S）型，可基本确定有陈旧性下壁心肌梗死。

Objective To investigate the value of differential diagnosis of the configuration of QRS complex in lead aVR in patients with inferior wall myocardial infarction. Methods The configuration of QRS in 52 patients with pathological Q-wave both in lead Ⅲand aVF were analyzed and the result of selective coronary arteriography was compared. Results 13 patients with the configuration of QRS in lead aVR appeared rS（ s）, while 10 patients appeared QS（qs） and 29 Q （q）r, correlated with 12,4 and 0 patients with coronary arteriography showed stenosis or occlusion lesion in right coronary artery or left circumflex artery （ χ2 = 35.56, P = 0.000）. Conclusions The configuration of QRS in lead aVR is helpful to differential diagnosis of the patients with pathological Q-wave both in lead Ⅲand aVF. Patients with the configuration of QRS in lead aVR appear rS（s） could be diagnosed as old myocardial infarction, but excluded from old myocardial infarction while appearing Q（q）r.