急性下壁心肌梗死左胸导联ST段下移的临床意义

Significance of Left Precordial ST Segment Depression in Patients with acute inferior myocardial infarction

目的 探讨急性下壁心肌梗死患者入院时心电图左胸导联ST段下移与临床预后及冠状动脉病变之间的关系。方法 选择收住院诊治并行冠状动脉造影术的急性下壁心肌梗死患者 72例 ,依据入院时心电图有无左胸导联ST段下移分为两组 ,无下移或下移 <0 1mV者为Ⅰ组 ,有下移且≥ 0 1mV者为Ⅱ组。结果 Ⅰ组 45例占 6 2 5 % ,Ⅱ组2 7例占 37 5 % ,Ⅱ组男性高龄者多 ,CK Mb峰值水平高 ,临床上合并低血压、Ⅱ°或Ⅲ°AVB、室颤、房颤、房扑、左心衰竭(Killip分级Ⅲ～Ⅳ级 )者较Ⅰ组高 ,P <0 0 5。住院病死率Ⅱ组高 ,P <0 0 5。冠状动脉造影Ⅱ组病人多支病变及合并前降支病变者显著增多 ,P <0 0 1。结论 急性下壁心肌梗死病人入院时心电图左胸导联ST段下移者临床合并症多 ,预后差 ,住院病死率高 ,冠状动脉病变多为多支病变及合并严重前降支病变 ,该类患者为急性下壁心肌梗死的高危患者。

Objective This study assessed the correlation between ST segment depression in leads (V 4～6 ) of admission ECG during acute inferior myocardial infarction (AMI) and clinical prognosis and coronary lesions. Methods 72 patients with inferior AMI who underwent coronary angiography (CAG) during hospitalization were classified into two groups on the basis of ST segment depression in leads V 4～6 : group Ⅰ=patients with no ST segment depression or ST segment depression <0 1 mV, Grop Ⅱ=those with ST segment depression≥0 1 mV. Results Group Ⅰ and group Ⅱ were 45 patients (62.5%) and 27 patients (37.5%), respectively, group Ⅱ included more men and old age, had higher peak CK MB levels, more frequently had hypotension, second and third degree atrioventricular block, ventricular fibrillation, atrial fibrillation, atrial flutter and decompensated left ventricular function (Killip score Ⅲ and Ⅳ), had higher hospital mortality than group Ⅰ, P<0 05 . According to CAG, it was shown that the patients with multivessel coronary disease or concomitant left anterior desending (LAD) artery disease were significantly increased in group Ⅱ, P<0 01 . Conclusion Among patients with inferior AMI, left precordial ST segment depression in admission ECG predicts increased complication, hospital mortality and ominous prognosis, multivessel coronary lesions or concomitant LAD artery lesion were often shown by CAG in these patients.