急性心肌梗死时体表心电图预测

    左主干闭塞的临床意义

    宫力红1

    赵维连1

    张大鹏1

    徐立1

    葛永贵1

    王红石1

    王乐丰1

    杨新春1

    [摘要] 目的:分析急性冠状动脉左主干(LM)闭塞的常规心电图( ECG)表现 ,总结其 ECG特点。方法:15

    例急性心肌梗死(AMI)患者经冠状动脉造影证实为急性LM 闭塞(LM 组) ,回顾性分析其急诊 ECG表现。并选

    取同时期 30 例左前降支(LAD)近段闭塞的 AMI患者(LAD组) ,比较 2 组造影前的急诊 ECG表现 ,以求总结急

    性LM 闭塞的常规 ECG特点。结果:LM 组心率快于LAD 组 ,心律失常发生率 2 组差异无统计学意义。LM 组

    中 13 例患者存在 aVR导联 ST 段抬高( ≥0. 05 mV) ,发生率明显高于 LAD 组(分别为 8617 %和 3617 % , P <

    0101) ,同时LM 组 aVR导联 ST段抬高幅度亦明显大于LAD组。而LM 组胸前导联 V1～3的 ST段抬高程度则

    明显低于LAD组。aVR导联 ST段抬高 > 0105 mV 诊断急性 LM 闭塞的敏感性为 90 % ,特异性为 6313 %。如

    果同时再满足 V1～3导联 ST段抬高程度 < 015 mV ,其诊断急性 LM 闭塞的敏感性为 90 % ,特异性达到 8617 %。

    结论:aVR导联 ST段抬高 ≥0105 mV ,同时伴有 V1～3导联 ST 段抬高不明显、 甚至压低是急性 LM 闭塞区别于

    LAD闭塞的 ECG特点 ,结合临床表现 ,分析 ECG特点可能有助于造影前预测此类患者和进行风险评价。

    [关键词] 心肌梗死;冠状动脉狭窄;心电描记术

    [中图分类号] R543. 1 [文献标志码] A [文章编号] 100121439 (2008) 0220111203

    Electrocardiographic characteristics in patients with acute myocardial

    infarction associated with lef t main artery obstruction

    GON G L i hong Z HAO Wei l i an Z HA N G Da pen g XU L I

    GE Yong g ui WA N G Hon gshi WA N G L e f eng YA N G X i nchun

    (Department of Cardiology , Beijing Chaoyang Ho spital , Cardiovascular Instit ute , Capital Uni2

    ver sity of Medical Science , Beijing , l00020 , China)

    Abstract Objective :The elect rocardiograms in patient s with AMI associated with lef t main (LM) artery ob2

    st ruction were analyzed ret rospectively to determine the elect rocardiographic features in this group of patient s.

    Method :From J an 1999 to J une 2007 ,acute LM obst ruction were confirmed in 15 patient s with AMI by emergency

    coronary angiography. The emergency elect rocardiograms before angiography in these 15 patient s (LM group) were

    analyzed ret rospectively , and their elect rocardiographic features were compared with those in 30 patient s with AMI

    resulted f rom proximal lef t anterior descending artery obst ruction ( LAD group ) . Result : There was no significant

    1

    首都医科大学附属北京朝阳医院心脏中心(北京 ,100020)

    通讯作者:宫力红 ,E2mail :66jinlang @163. com

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    (收稿日期:2007203214)

    · 111 · 临床心血管病杂志2008 年2 月第24 卷第2 期difference in occurrence of arrhythmia between the two groups. Heart rate in the LM group was higher than that in

    the LAD group. The occurrence rate and degree of ST segment elevation in lead aVR were both significantly high2

    er in the LM group compared with the LAD group. The degree of ST segment elevation in lead V1 , V2 and V3

    were also lower in the LM group compared with the LAD group . ST elevation in aVR predicted LM obst ruction

    with sensitivity of 90 % and specificity of 6313 %. Both ST elevation in aVR ( > 0105 mV) and minor ST elevation

    in V1～3 (total level < 015 mV) represented lef t main obst ruction with sensitivity of 90 % and specificity of 8617 %.

    Conclusion :ST elevation in aVR with minor ST elevation in V1～3 is an important predictor of acute lef t main artery

    obst ruction.

    Key words Myocardial infarction ; Coronary stenosis ; Elect rocardiography

    急性冠状动脉左主干(LM)闭塞导致的急性心

    肌梗死(AMl)患者病情凶险 ,病死率高 ,大部分患

    者可能没有机会到达医院接受冠状动脉造影

    (CA G)确诊 ......