急性下壁心肌梗死时胸前和(或)侧壁导联ST段压低的意义

Implication of ST-segments depression on precordial and/or lateral leads in acute inferior myocardial infarction

目的 :探讨急性下壁心肌梗死 (AIMI)时心电图胸前导联和侧壁导联 ST段压低的意义。方法 :36例AIMI患者依据有无胸前导联和 (或 )侧壁导联 ST段压低分为 ST段压低组 (甲组 )和无 ST段压低组 (乙组 )。对两组间肌酸激酶峰值 ,射血分数及病变冠状动脉血管分布、多支冠状动脉病变进行了比较 ,并对临床可能的危险因子进行了 L ogistic多元回归分析。结果 :侧壁导联 ST段压低危险度与 、 、a VF导联的 ST段抬高值相关(OR=4.185 9,P <0 .0 5 ) ,与 V1～ 3 导联 ST段压低值相关 (OR=5 .0 6 87,P <0 .0 5 ) ,同时 ,随着左回旋支 (L CX)狭窄的加重 ,侧壁导联 ST段压低概率有增加倾向 (OR=3.3774,P >0 .0 5 )。胸前导联 ST段压低危险度仅与 、a VL 导联的 ST段压低值相关 (OR=5 .3743,P <0 .0 5 )。结论 :AIMI侧壁导联 ST段压低与 、 、a VF抬高程度有关 ,同时提示可能伴有 L CX病变 ,而胸前导联 ST段压低则反映了侧壁心肌缺血。

Objective:To investigate the significance of ST-segments depression in precodial and/or lateral leads in patients with acute inferior myocardial infarction (AIMI).Method:36 patients with AIMI were divided into ST-segment depression group (Group A,n=22) and Non-ST segment depression group (Group B,n=14).Peak value of creatine kinase (CK),ejection fraction (EF) and the distribution of diseased coronary vessel,multi-vessel stenosis were compared between them.Logistic regression were performed to find out the clinic risk factors.Result:ST-segment depression in lateral leads was related to ST-segment elevation in Ⅱ,Ⅲ,aVF (OR= 4.185 9 ,P< 0.05 )and ST-segment depression in V 1~3 (OR= 5.068 7 ,P< 0.05 );and ST-segment in lateral lead tended to be depressed as the stenosis of LCX increased (OR= 3.377 4 ,P> 0.05 ).ST-depression on precordial lead was only related to ST-segment depression in lateral lead (OR= 5.374 3 ,P< 0.05 ).Conclusion:Lateral leads ST-segment depression in patients with AIMI related to the elevation of Ⅱ,Ⅲ,aVF and had a tendency in relation with lesion of LCX.ST-segment depression in precordial leads implys the myocardial ischemia of lateral wall.