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目的探讨心电图判断高危急性下壁心肌梗死患者梗死相关冠脉(IRA)的价值。方法选择2001年10月～2008年7月住院的急性下壁心肌梗死患者44例,对患者的临床资料、体表心电图及冠状动脉造影资料进行回顾性分析,将出现低血压、缓慢性心律失常、休克三个并发症之一的患者作为高危组,不出现任何并发症者为低危组。结果①STV3↓/STⅢ↑<0.5者高危组(76.47%)多于低危组(44.44%),0.5≤STV3↓/STⅢ↑<1.2和STV3↓/STⅢ↑≥1.2,高危组(17.64%和5.88%)分别低于低危组(40.74%,14.81%)(p<0.01);STV3R～V5R↑在高危组高于低危组(23.52%vs.7.40%),STV7～V9↑在高危组低于低危组(5.88%vs.22.22%)(p<0.01);②IRA为RCA近端病变者,高危组(70.58%)明显高于低危组(11.11%)(p<0.01);高危组中2支(47.05%vs.33.33%)、3支(47.05%vs.37.03%)病变明显多于低危组,而单支病变的例数少于低危组(5.88%vs.26.62%)(p<0.05)。结论常规体表心电图指标是判断急性下壁心肌梗死的罪犯血管及梗死部位的良好方法。
Objective To investigate the value of electrocardiogram (ECG) in the diagnosis of infarction related coronary artery (IRA) in patients with high risk acute inferior myocardial infarction. Methods Forty-four patients with acute inferior myocardial infarction hospitalized from October 2001 to July 2008 were retrospectively analyzed. The clinical data, body surface electrocardiogram and coronary angiography data were retrospectively analyzed. Hypotension, bradyarrhythmia , Shock one of the three complications of patients as a high-risk group, no complications were low-risk group. Results ① The high-risk group (76.47%) had more STV3 ↓ / STⅢ ↑ <0.5 than the low-risk group (44.44%), 0.5≤STV3 ↓ / STⅢ ↑ <1.2 and STV3 ↓ / STⅢ≥1.2, (40.74%, 14.81%, respectively) (p <0.01). STV3R ~ V5R ↑ was higher in the high-risk group than in the low-risk group (23.52% vs.7.40% (0.88% vs.22.22%) (p <0.01); ② IRA was the proximal RCA lesions in high risk group (70.58%) was significantly higher than the low risk group (11.11%) (p <0.01) (47.05% vs.33.03%) and 3 (47.05% vs.37.03%) lesions were significantly higher than those in the low-risk group, while the number of single-vessel lesions was less than that of the low-risk group (5.88% vs.26.62% (p <0.05). Conclusion Conventional surface ECG is a good way to judge the culprit vessels and infarction area of acute inferior myocardial infarction.