急性下壁心肌梗死心电图胸前导联V1-3 ST段抬高的临床意义

Clinical significance of precordial ST segment elevation in patients with acute inferior myocardial infarction

目的 探讨急性下壁心肌梗死患者心电图胸前导联ST段抬高与冠状动脉造影所示冠状动脉病变的关系及其临床意义.方法 187例急性下壁心肌梗死患者,按入院时18导心电图胸前导联ST段改变分为2组,ST段抬高组（16例）和非ST段压低组（171例）.所有患者均行冠状动脉造影术,病变适合行经皮腔冠状动脉成型术并检测B型钠尿肽（BNP）.结果 急性下壁心肌梗死伴胸前导联ST段抬高时多为右冠状动脉近段闭塞,尤其是圆锥支闭塞（P＜0.01）,且伴有右心功能不全和血流动力学障碍,与下壁右室心梗相比BNP差异有统计学意义（P＜0.01）.结论 急性下壁心肌梗死合并胸前导联ST抬高表明为右冠状动脉近段或开口闭塞且多伴右室心肌梗死和心功能不全.

Objective To study the significance of precordial ST segment elevation in patients with acute inferior infarction and its relation with the lesion of coronary artery.Methods 187 patients with first acute inferior myocardial infarction were divided into two groups based on the chest lead ST segment elevation or no ST segment elevation admission electrocardiogram,ST segment elevation（n=16）,no ST segment depression（n=171）.All patients underwent angiography and the level of serum BNP was measured,according to the angiogram,patients could received PCI.Results In mostly,acute inferior myocardial infarction with precordial ST segment elevation indicated the proximal occlusion of RCA,especially conus branch occlusion（P＜0.01）,which companion with right myocardial infarction and ventricular heart fail.Conclusion The precordial leads ST segment elevation in patients with acute inferior myocardial infarction suggests occlusion of proximal RCA,and often companion right myocardial infarction and cardiac failure.