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目的分析急性前壁心肌梗死的梗死相关血管特点和心电图分布特征,为临床判断冠状动脉病变部位提供线索。方法经冠状动脉造影证实为单支血管病变的142例初发急性前壁心肌梗死患者,根据心电图表现分为四组。比较各组间梗死相关动脉的病变特点。结果单纯前壁心肌梗死的犯罪血管病变82%(3644)在前降支中段,前壁心肌梗死合并下壁导联ST段压低的犯罪血管病变80%(2430)在前降支近段,前壁心肌梗死合并下壁导联ST段抬高者,犯罪病变54%(2037)在右冠状动脉,46%(1737)在左前降支,广泛前壁心肌梗死的犯罪病变主要在前降支近段85%(2327),P<0.001;前壁心肌梗死是否合并下壁导联ST段偏移,其血管病变程度与侧支循环建立相近,均好于广泛前壁心肌梗死患者。结论根据心肌梗死时心电图异常的分布特点,可以推测急性前壁心肌梗死病变的部位,良好的侧支循环有助于限制梗死面积。
Objective To analyze the characteristics of infarction-related blood vessels and the distribution of electrocardiograms in patients with acute anterior myocardial infarction, and provide clues for the clinical diagnosis of coronary lesions. Methods 142 cases of newly diagnosed acute anterior myocardial infarction confirmed by coronary angiography were divided into four groups according to the ECG findings. The characteristics of infarction-related arteries in each group were compared. Results In the anterior descending artery, 82% (3644) of the culprit vascular lesions were isolated from the anterior wall of the anterior descending artery in anterior segment of the anterior descending artery In patients with myocardial infarction complicated with ST segment elevation in the inferior leads, 54% (2037) of the criminal lesions were in the right coronary artery and 46% (1737) in the left anterior descending artery. The majority of criminal lesions in anterior myocardial infarction were mainly in the anterior descending artery (2327), P <0.001; whether anterior wall myocardial infarction with ST-segment deviation of the inferior leads leads to a similar degree of vascular lesions compared with that of collateral circulation, which is better than that of extensive anterior myocardial infarction. Conclusion According to the distribution of ECG abnormalities during myocardial infarction, we can infer the location of acute anterior myocardial infarction and good collateral circulation to help limit infarct size.