右心室心肌梗塞的诊断与治疗

The diagnosis and treatment of right ventricular infarction.

目的 探讨右心室心肌梗塞的临床诊断与治疗.方法 对50例急性右心室心肌梗塞(RVI)患者临床资料进行分析.结果 发现RVI合并左室梗塞占94%,单纯性RVI占6%.二度以上房室传导阻滞发生率28%,窦性心动过缓22%,室颤8%.低血压或休克发生率28%.死亡率30%,主要死因为难以控制的休克或急性左心衰.结论 RVI常合并其他部位梗塞,心律失常和休克发生率高,死亡率高.心电图V_(3R)～V_(6R)相邻≥2个导联ST段抬高≥1mm是诊断RVI的可靠指标.治疗上重视扩容,慎用血管扩张剂,每天补液量2500～3500ml对多数RVI患者适宜,但个体差异大,应注意过份扩容诱发急性左心衰.

ve To investigate the clinical diagnosis and treatment of RVI. Methods The clinicaldata of 50 cases of RVI were analysed. Results 94% RVI were complicated with LVI, or 28% RVI with II degreeor over of atrial ventricular conductive interruption, 22% with sinus bradycardia, 8% with ventricular vibration,28% with low blood pressure or shock. The mortality was 30%, the cause of death was mainly shock or left heartfailure. Conclusions RVI was often complicated with other regional infarction, with higher mortality, with highermorbidity of arrhythmia and shock. RVI can be diagnosed with ECG and can be treated with reasonable circularvolume and diastolo - vascular medicine.