论文部分内容阅读
急性心肌梗塞对应性ＳＴ段下移的临床意义山西医学院第二附属医院（０３０００１）秦沛临，王凤芝，陈臣义山西省卫生厅卫生所李玉清急性心肌梗塞（ＡＭＩ）时，对应性ＳＴ段下移（Ｒ－ＳＴ－Ｄ）常见，过去均以镜像改变来解释，但８０年代以来有关研究多认为可能预示较大范围梗塞或对应部位心肌缺血及无Ｑ波性心肌梗塞，因而受到临床重视。本文结合我院资料，进一步探讨Ｒ－ＳＴ－Ｄ的临床意义。对象与方法本文１０９例系我院１９８４～１９９１年收治的首次ＡＭＩ并捕获了心电图ＳＴ段抬高的患者。ＡＭＩ的诊断按ＷＨＯ公布的标准，根据症状、心电图和酶学改变综合判定。Ｒ－ＳＴ－Ｄ采用Ｆｅｒｇｕｓｏｎ［１］标准，即与梗塞部位相对应的最少两个导联ＳＴ段水平型或斜下型下移≥０．ｌｍｖ，且除外室内阻滞。下壁梗塞时Ｖ１－４为对应导联；前壁梗塞时对应导联为Ⅱ、Ⅲ、ａｖＦ。上述Ｒ－ＳＴ－Ｄ与梗塞区抬高的ＳＴ段呈同步性演变称为镜像改变［２］。依据该标准将１０９例患者分组进行对比分析：（１）无Ｒ－ＳＴ－Ｄ在；（２）Ｒ－ＳＴ－Ｄ非同步（演变）组；（３）Ｒ－ＳＴ－Ｄ同步（演变）组。（２）和（３）组又按Ｒ－ＳＴ－Ｄ总和≥０．８ｍｖ或＜０．８ｍｖ各自分为两个亚组。结果结果表明
Clinical significance of ST-segment downcorrespondence in acute myocardial infarction correspondence ST Jun-lin, WANG Feng-zhi, CHEN Chen-yi At the time of acute myocardial infarction (AMI) -ST-D) are common, the past are used to explain the changes in the mirror, but more studies since the 1980s that may predict a larger area of infarction or corresponding myocardial ischemia and Q-wave myocardial infarction, which received clinical attention. This article combined with our hospital data to further explore the clinical significance of R-ST-D. Subjects and Methods 109 cases of our hospital from 1984 to 1991 admitted to the first AMI and capture of ST-segment elevation in patients with ECG. The diagnosis of AMI according to WHO published standards, according to the symptoms, ECG and enzymatic changes comprehensive judgment. R-ST-D using Ferguson [1] standard, which corresponds to the infarct with a minimum of two lead ST segment horizontal or oblique downward ≥0. lmv, and with the exception of indoor block. V1-4 inferior wall infarction for the corresponding lead; anterior infarction corresponding leads for the II, III, avF. Synchronous evolution of R-ST-D and ST elevation in the infarct region is called a mirror image change [2]. According to the criteria, 109 patients were grouped for comparative analysis: (1) R-ST-D was not present; (2) R-ST-D was not synchronized group. Groups (2) and (3) were further divided into two subgroups according to the sum of R-ST-D ≥0.8 mv or <0.8 mv respectively. The results show that