急性前壁心肌梗死时Ⅰ和aVL导联ST段抬高的临床意义

Clinical Significance of ST - segment Elevations in Leads I and aVL in Patients with Anterior Acute Myocardial Infarction

目的:探讨急性前壁心肌梗死(AAMI)时I和aAL导联ST段抬高的临床意义。方法:回故性分析96例初发Q波型AAMI患者的心电图(ECG),肌酸激酶(CK)及其同功酶(CK-MB)峰值,住院期间临床主要并发症及死亡率等资料。结果:与单纯AAMI患者(B组)比较,AAMI伴I和aVL导联ST段抬高患者(A组)中对应下壁导联(Ⅱ,Ⅲ,aVF)ST段压低的比例明显增加(P<0.005),CK及CK-MB峰值水平明显增高(P均<0.001),梗死后心绞痛、恶性室性心律失常、心力衰竭的发生率及死亡率明显增高(P均<0.05),心源性休党的发生率也有增加趋势,但无统计学意义(P>0.05)。结论:I和aVL导联ST段抬高对判断AAMI患者的梗死范围及近期预后有重要价值。

Objective: To study the clinical significance of ST - segment elevations in leads I and aVL in patients with anterior acute myocardial infatction(AAMI) .Methods: The changes of ECG and the peek levels of CK and CK - MB and complications and mortality were analyzed in 96 patients with first time Q wave AAMI . Results: In comparison with patients with isolate AAMI(group B), the percentage of patients with ST - segment depression of Ⅱ , Ⅲ ,aVF≥1 mm was higher (P < 0.005) ,peak levels of CK and CK - MB were higher( P < 0.001) and the incidences of postinfaretion angina, severe ventricular arrhythmia , heart failure and mortality were higher (P < 0.005 - 0.01) in AAMI with ST - segment elevations in leads I and aVL patients (group A) . The incidence of cardiogenic shock was higher in group A patients than that in group B patients, but there was no significant difference between the two groups (P > 0.05). Conclusion: segement elevations in leads I and aVL in AAMI has significant value in predicting size of myocardial infarction and early clinical prognosis.