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目的:急性下壁心肌梗死早期常伴有胸前导联ST段压低,以往认为是一种对应性镜像反映[1],近年来则提出较多异议。它能否作为判断合并前支病变的依据,对临床诊治及判断有十分重要的意义。方法:本文分析了60例急性下壁心肌梗死(AIMI)患者胸前导联ST段压低变化和其冠状动脉造影结果,以探讨胸前导联ST段变化与前降支病变的关系。结果:急性下壁心肌梗死60例中,胸前导联ST段下移者41例,胸前导联ST段正常者19例。前者CK最高峰值达2356±1036,后者CK峰值最高达1630±421,P<0.01,冠状动脉显示右冠状段异常的41例中,4例死亡。KILLIPⅡ级以上心力衰竭15例,发生36.6%;心率失常30例,发生率73.2%,胸前导联ST段正常的19例中Ⅱ级以上心力衰竭2例,发生率10.5%,心率失常7例,发生率36.8%,P值均为P<0.05。结论:急性下壁心肌梗死胸前导联V1-V3ST段压低是急性下壁心肌梗死镜像改变,而伴胸前导联V4-V6ST压低则可能存在左前降支和/或回旋支的严重狭窄病变,存在较大面积,临床出现血流动力学紊乱,应引起重视。
OBJECTIVE: In the early stage of acute inferior myocardial infarction, the ST-segment depression of the anterior thoracic lead is often accompanied by a corresponding mirror image [1]. In recent years, more objections have been proposed. Whether it can be used as a basis to judge the former branch of the disease, is of great significance to clinical diagnosis and treatment. Methods: The changes of ST-segment depression and coronary angiography in 60 patients with acute inferior wall myocardial infarction (AIMI) were analyzed in this paper to investigate the relationship between ST-segment changes in the anterior chest lead and the lesions of the anterior descending branch. Results: 60 cases of acute inferior myocardial infarction, thoracic lead ST segment down in 41 cases, thoracic lead ST segment normal in 19 cases. The former peaked at 2356 ± 1036, while the latter peaked at 1630 ± 421, P <0.01. Among the 41 cases with coronary right coronary artery anomalies, 4 died. KILLIP Ⅱ grade 15 cases of heart failure, occurred in 36.6%; 30 cases of arrhythmia, the incidence rate of 73.2%, 19 cases of chest lead ST segment normal grade 2 heart failure in 2 cases, the incidence of 10.5%, 7 cases of arrhythmia , The incidence of 36.8%, P values were P <0.05. CONCLUSIONS: The reduction of V1-V3ST segment in the anterior chest lead of acute inferior myocardial infarction is a mirror image of acute inferior wall myocardial infarction. However, with the decrease of V4-V6ST in the anterior chest lead, there may be severe stenosis of left anterior descending artery and / or circumflex artery , There is a large area, clinical hemodynamic disorders, should pay attention.