急性下壁心肌梗死伴胸前导联ST段压低与冠状动脉病变的关系及临床意义

Clinical Significance of Precordial ST Segment Depression in Acute Inferior Myocardial Infraction and its Relation with Lesion of Coronary Artery

为探讨下壁急性心肌梗死(AMI)患者心电图胸前导联ST段压低与冠状动脉造影所示的冠状动脉病变的关系,将68例下壁AMI患者按心电图胸前导联ST段下降范围分为3组:Ⅰ组(n=19):胸前导联ST段无明显下降;Ⅱ组(n=14):Ⅴ_(1～3)导联ST段下降;Ⅲ组(n=35):Ⅴ_(1～5)或Ⅴ_(1～6)导联ST段下降。结果:Ⅰ组、Ⅱ组、Ⅲ组前降支病变的发生率分别为26.3％、14.3％、74.3％,ST段下降组较无ST段下降组冠状动脉多支病变的发生率增加(P<0.01),Ⅲ组前降支狭窄程度≥90％的有34.3％,Ⅰ组、Ⅱ组前降支狭窄程度均<90％。结果提示:下壁AMI伴胸前导联Ⅴ_(1～5)或Ⅴ_(1～6)导联ST段下降者大多数合并前降支病变,主要原因是前降支严重狭窄致前壁心内膜下心肌缺血,它可作为早期甄别下壁AMI重危患者的一项指标,而Ⅴ_(1～3)导联ST段下降可考虑是一种对应性改变。

To study the significance of precordial ST segment depression in acute inferior myocardial infraction and its relation with lesion of coronary artery, 68 patients with inferior AMI were allocated into three groups based on the extent of precordial ST segment depression. Group 1(n = 19) had no precordial ST segment depression. Group 2( n = 14) had ST segment depression in V1-3. Group 3(n-35) had ST segment depression in V1-5 or V1-6. Results: The frequency of disease of left anterior descending artery(LAD) was 26.3% in group 1, 14.3% in group 2, 74.3% in group 3. The patients with LAD stenosis of more than 90% accounted for 34. 3% in group 3. The precordial ST segment depression in V1-5 or V1-6 in patients with inferior AMI suggest the presence of LAD lesion. The cause of ST segment depression in V1-5 or V1-6, may be due to anterior wall subendocardial ischemia caused by severe stenosis of LAD, and precordial ST segment depression in V1-3 indicates a reciprocal change.