急性心肌梗死梗死区与非梗死区导联的ST段改变

Changes of ST segments in acute myocardial infarction region and non-infarction region

目的 探讨急性心肌梗死梗死区与非梗死区导联ST段变化及临床意义。 方法 36例急性前壁心肌梗死 (AAMI)和 2 8例急性下壁心肌梗死 (AIMI)患者 ,对梗死区与非梗死区导联ST段变化及其与冠状动脉造影结果作相关分析。 结果 AAMI有下壁导联ST段压低中Ⅰ、avL导联ST段抬高占70 .5 9% (P <0 .0 1) ,左前降支近段病变占 76 .4 7% ,而冠脉多支病变与ST段压低差异无显著性。AIMI组Ⅰ、avL导联ST段压低占 71.4 2 % ,冠脉多支病变中Ⅴ4～Ⅴ6导联ST段压低占 5 2 .17% (P <0 .0 1)。 结论 AAMI或AIMI时Ⅰ、avL与Ⅱ、Ⅲ、avF导联ST段抬高与压低呈对应“镜像”改变 ;AAMI时下壁导联ST段压低 ,病变多位于左前降支近段 ,梗死面积大 ;AIMI时Ⅴ4～Ⅴ6的ST段压低则反映冠脉多支病变。AMI的ECG早期鉴别诊断有助于识别高危患者。

Objective To explore the changes of ST segments in acute myocardial infarction region and non infarction region and their clinical significance. Methods The ECG changes of 36 patients with acute anterior myocardial infarction (AAMI) and 28 patients with acute inferior myocardial infarction(AIMI) were analyzed. The relationship between the changes and coronary artery lesions was discussed. Results ST segments uplift was found in 70.59% of patients who showed inferior leads ST depression in AAMI presented and proximal lesion of left anterior descending coronary artery (LAD) was 76.47%. But there was no significant difference between inferior leads ST depression group and non depression group in multi vessel disease. In AIMI, ST depression in Ⅰ?avL was 71.42% and 52.17% of patients with multi vessel disease showed ST depression in leads Ⅴ 4～Ⅴ 6 (P<0.01). Conclusion There is a corresponding 'mirror' change of ST segments uplift and depression of Ⅰ,avL,Ⅱ,Ⅲ,avF in patients with AAMI or AIMI. ST depression of inferior leads in AAMI predicts proximal lesion in LAD; ST depression of leads Ⅴ 4～Ⅴ 6 in patients with AIMI predicts multi vessel disease. Early differential diagnosis with ECG of acute myocardial infarction is helpful to recognize high risk patients.