急性ST段抬高型心肌梗死心电图与冠状动脉造影的相关性研究

The correlation between ECG and coronary angiography in patients with acute ST segment elevation myocardial infarction

目的通过对比分析急性ST段抬高型心肌梗死心电图与冠状动脉造影的特点,探讨心电图对梗死相关动脉的定位诊断价值。方法采用回顾性分析的方法,选取急性ST段抬高型心肌梗死行PCI术的病例60例,记录患者的年龄、性别、心电图、冠脉造影检查结果,将心电图与冠脉造影结果进行比较,确定心电图梗死相关动脉的定位诊断作用。结果前壁心肌梗死17例、广泛前壁心肌梗死7例、前间壁心肌梗死4例均为前降支闭塞,其心电图胸前导联ST段抬高,且以V2最为明显。32例下壁心肌梗死中,闭塞血管多为右主干或回旋支。其心电图表现为Ⅱ、Ⅲ、av F导联ST段抬高的特征,右冠闭塞所致的下壁心肌梗死与回旋支闭塞所致下壁心肌梗死相比,其Ⅲ导联ST段抬高较Ⅱ导联ST段抬高更为明显,且常伴有av L导联ST段压低,回旋支闭塞致下壁心肌梗死常伴有胸前导联ST段压低,差异有统计学意义(P<0.05)。结论心电图的特征性改变对于急性ST段抬高型心肌梗死罪犯血管的确定有较高的预测价值。

Objective To discuss the localization diagnosis function of ECG in acute myocardial infarction cases,by contrasting the results of electrocardiogram （ECG） of acute myocardial infarction with Coronary angiography. Methods This project used a retrospective analysis method, 60 cases with acute ST segment elevation myocardial infarction un- dergoing percutaneous coronary intervention （PCI） were selected, the patient＇s age, gender, electrocardiogram and coro- nary angiography results, ECG and coronary angiography results were record and compared, to determine the location diagnostic value of electrocardiogram infarct related artery. Results 17 cases of anterior wall myocardial infarction, 7 cases of extensive anterior wall myocardial infarction, 4 cases of anteroseptal myocardial infarction was anterior de- scending branch occlusion, the precordial ST segment elevation and V2 was most obvious. 32 cases of inferior wall my- ocardial infarction, the occlusion of blood vessels for the right trunk or cyclotron. The ECG characteristics of II, III and AVF lead ST segment elevation and right coronary occlusion due to inferior wall myocardial infarction and cyclotron branch occlusion induced by myocardial infarction compared, III lead ST segment elevation was II lead ST segment ele- vation is more obvious, and often accompanied by AVL lead ST segment depression and back to the circumflex branch occlusion in inferior wall acute myocardial infarction often accompanied by preeordial ST segment depression, the dif- ference was statistical significant （P〈0.05）. Conclusion The characteristic of ECG for acute st-elevation myocardial infarction lesions in the determination of blood vessels have higher predictive value.