牛杰,孙丽杰,郭静萱,张萍,郭丽君,毛节明,陈明哲

• 1: 北京大学第三医院心内科
• 2:北京大学第三医院心内科
• 3:北京大学第三医院心内科
• 4:北京大学第三医院心内科

摘要(Abstract)：

目的探讨急性前壁心肌梗死时的常规心电图(ECG)对前降支(LAD)闭塞部位的预测价值。方法根据冠状动脉造影的结果,以第一间隔支(S1)为标志将患者分为S1近端病变(PS)组(61例)和S1远端病变(DS)组(40例)。分别测量常规ECG12导联ST段的偏移程度及出现的频率,以计算、比较两组之间的差异及其对近、远段病变部位的预测性诊断价值。结果(1)各导联诊断LAD近端病变的敏感性和特异性分别为:aVR导联ST段抬高为43%和85%(P=0.004);aVL导联ST段抬高≥1.5mm为16%和97%(P=0.031);Ⅱ导联ST段下移≥1.0mm为39%和85%(P=0.009);Ⅲ导联ST段下移≥2.0mm为23%和98%(P=0.005);aVF导联ST段下移≥1.0mm为38%和88%(P=0.006);V5导联ST段下移为20%和86%(P=0.037);aVR导联ST段抬高同时伴V5导联ST段下移为18%和100%(P=0.005);aVR导联ST段抬高同时伴V6导联ST段下移为30%和93%(P=0.008);(2)各导联诊断LAD远端病变的敏感性和特异性分别为:Ⅲ导联ST段居于等电位线或抬高为53%和90%(P=0.000);V5导联ST段抬高≥1.5mm为50%和82%(P=0.001);(3)近、远端患者的梗死面积和心功能水平未见明显差异。结论(1)aVR导联ST段抬高同时出现V5、V6导联ST段下移;下壁导联Ⅱ、Ⅲ、aVF导联ST段明显下移(Ⅱ,aVF导联ST段下移≥1.0mm,STⅢ下移≥2.0mm)以及Ⅰ,aVL导联ST段抬高,尤其是aVL导联ST段抬高≥1.5mm均提示LAD近端病变。(2)下壁导联(尤其是Ⅲ导联)ST段居于等电位线或升高,V5导联ST段抬高≥1.5mm均提示LAD远端病变。

关键词(KeyWords)： 心肌梗死;心电描记术;冠状血管;动脉硬化,闭塞型

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 牛杰,孙丽杰,郭静萱,张萍,郭丽君,毛节明,陈明哲

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