梗死性室性异位心搏的临床及心电学特点

The Clinical and Electrocardiographic Character of Infarctional Ventricular Ectopic Beats.

探讨梗死性室性异位心搏 (IVEB)的临床及心电学特点。对 2 4例在急性心肌梗死 (AMI)时出现IVEB的患者与同期住院的 71例无IVEB的AMI患者进行回顾性对照分析 ,并比较IVEB和同期与梗死充分进展期窦性心律的QRS ST T波群形态学改变。结果 :①IVEB的QRS波常呈右束支阻滞形态 (RBBBM) ,除Q波型AMI外 ,非Q波型AMI亦可发生IVEB ;②下 (后 )壁伴或不伴右室AMI、大面积AMI、梗死后心功能差、梗死早期 (<6h)及接受溶栓治疗冠状动脉再通者易发生IVEB ;③与同期窦性心律比较 ,IVEB梗死导联Q波出现及ST段抬高提早 ,且更具有AMI的特征 ;④IVEB可发生于心肌酶谱升高及窦性心律典型AMIECG图形出现之前 ,其对AMI的早期诊断及定位优于同期窦性心律。结论 :IVEB并非罕见 。

To explore the clinical and electrocardiographic character of infarctional ventricular ectopic beats (IVEB),24 acute myocardial infarction(AMI) patients with IVEB and 71 AMI patients without IVEB were analysed.The morphlogical changs of QRS complex,ST segment,T wave were compared IVEB with sinus rhythm of same period and fully evolved phase.Results:①IVEB QRS complex often revealed the right bundle branch block morphology(RBBBM),beside Q wave AMI,no Q wave AMI had IVEB;②IVEB were positive correlation with the early AMI,AMI size,killip heart function degree,inferoposterior with/without right ventricular involvement and thrombolytic reperfusion;③The Q wave of IVEB was winder and ST segment elevation was higher than that of the same period sinus rhythm;④The infarctional morphological changs of IVEB could be found before the same period sinus rhythm and myocardial enzyme rise.Conclusion:IVEB was not rare,they were always useful to early diagnosis and location of AMI.