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目的:探讨急性下壁心肌梗死患者的体表心电图对梗死相关血管及闭塞部位的预测价值。方法:对62例急性下壁心肌梗死患者的体表心电图和冠状动脉造影资料进行回顾性对比分析。结果:梗死相关血管为右冠状动脉者50例(80.65%),左回旋支者12例(19.35%)。单纯急性下壁心肌梗死多发生在右冠状动脉中远段(62.07%);并发右室梗死者均发生在右冠状动脉,且多发生在右冠状动脉近段(70.00%)。STⅢ抬高/STⅡ抬高>1、STaVL压低≥0.5mm、STV1抬高≥0.5mm、STV3压低/STⅢ抬高≤1.2提示梗死相关血管为右冠状动脉的灵敏度分别为88.00%、90.00%、66.00%、72.00%,特异度分别为58.33%、75.00%、83.33%、66.67%。STⅢ抬高/STⅡ抬高≤1、STaVL呈等电位线或抬高、STV1压低≥0.5mm、STV3压低/STⅢ抬高>1.2提示梗死相关血管为左回旋支的灵敏度分别为58.33%、75.00%、66.67%、66.67%,特异度分别为88.00%、90.00%、80.00%、72.00%。结论:急性下壁心肌梗死时,体表心电图对梗死相关血管及闭塞部位有重要的预测价值。
Objective: To investigate the predictive value of body surface electrocardiogram (ECG) on infarction-related blood vessels and occlusion sites in patients with acute inferior myocardial infarction. Methods: The electrocardiogram and coronary angiography data of 62 patients with acute inferior myocardial infarction were retrospectively analyzed. Results: Fifty patients (80.65%) had right coronary artery and 12 patients (19.35%) had left circumflex artery. Acute simple inferior myocardial infarction occurred mostly in the middle and distal segments of the right coronary artery (62.07%). All of the patients with right ventricular infarction occurred in the right coronary artery and most often in the proximal coronary artery (70.00%). ST Ⅲ elevation / ST Ⅱ elevation> 1, STaVL depression ≥0.5mm, STV1 elevation ≥0.5mm, STV3 depression / STⅢ elevation ≤1.2 suggest that the sensitivity of infarction related vessels to right coronary artery are 88.00%, 90.00%, 66.00 %, 72.00% and specificity of 58.33%, 75.00%, 83.33%, 66.67% respectively. ST Ⅲ elevation / ST Ⅱ elevation ≤1, STaVL was isoelectric line or elevation, STV1 depression ≥0.5mm, STV3 depression / STⅢ elevation> 1.2 suggested that the sensitivity of the infarct-related artery for the left circumflex artery were 58.33%, 75.00% , 66.67%, 66.67% respectively, the specificity was 88.00%, 90.00%, 80.00%, 72.00% respectively. CONCLUSION: Body surface electrocardiogram has important predictive value for infarct-related blood vessels and occlusion sites during acute inferior myocardial infarction.