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急性下壁心肌梗死伴有胸前导联ST段压低的临床意义(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2009年第4期
页码:
547-549
栏目:
临床研究
出版日期:
2009-06-25

文章信息/Info

Title:
Clinical implication of precordial ST segment depression in patients with acute inferior myocardial infarction
作者:
富路; 张师义; 屈昌芝
哈尔滨医科大学附属第一临床学院心内科，黑龙江 哈尔滨 150001
Author(s):
FU Lu;  ZHANG Shi-yi;  QU Chang-zhi
Department of Cardiovascular Diseases, First Affiliated Hospital, Haerbin Medical University, Haerbin 150001, Heilongjiang, China
关键词:
心肌梗死; 急性; 下壁; 胸前导联ST段压低; 冠状动脉多支病变
Keywords:
acute inferior myocardial infarction;  precordial ST segment depression;  multivessel lesion
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
目的 分析急性下壁心肌梗死（acute inferior myocardial infarction，AIMI）伴有胸前导联ST段压低的冠状动脉病变特点及临床意义。方法 回顾分析2006年8月～2007年8月住院的AIMI患者91例。按胸前导联ST段是否压低将患者分为4组:胸前导联ST段无压低组（n=27）;胸前导联仅V1～4 ST段压低组（n=26）;胸前导联仅V5～6 ST段压低组（n=12）；广泛胸前导联ST段压低组（n=26）。结果 AIMI伴有胸前导联V1～4 ST段压低与冠状动脉多支病变呈负相关，ORⅢ=0.38,无统计学意义；AIMI伴有胸前导联V1～6 ST段压低与冠状动脉多支病变呈正相关，ORⅣ=5.25,P<0.01,有显著统计学意义。胸前导联V1～6 ST段压低组与其他组相比较，左室射血分数（LVEF）低，差异显著（P<0.05）；该组前降支病变率高（73.1%），但与其他3组相比无统计学差异。结论 AIMI伴有胸前导联V1～6 ST段压低提示多支病变,且心功能不全发生率高。
Abstract:
AIM: To investigate the relationship between coronary lesion characteristics and precordial ST segment depression and its clinical implication in patients with acute inferior myocardial infarction (AIMI). METHODS: Ninety one patients with the first AIMI were divided into four groups on the basis of admission electrocardiograms: Group I—patients with no precordial ST segment depression (n=27), Group II—patients with ST segment depression in leads V1 to V4 (n=26), Group III—patients with ST segment depression in leads V5-V6 (n=12) and Group IV of patients with ST segment depression in leads V1-V6 (n=26). RESULTS: V1-V4 ST segment depression in AIMI was negatively correlated with multivessel lesion (ORIII=0.38, P>0.05), whereas V1-V6 ST segment depression in AIMI was positively correlated with multivessel lesion (ORIV=5.25, P<0.01) and lower left ventricular ejection fraction (P<0.01). CONCLUSION: V1-V6 ST segment depression in AIMI suggests higher incidence of multivessel lesion and heart failure.

参考文献/References

［1］ Peterson ED, Hathaway WR, Zabel KM, et al. Prognostic significance of precordial ST segment depression during inferior myocardial infarction in the thrombolytic era:results in 16,521 patients［J］. J Am Coll Cardiol, 1996, 28(2):305-312.

［2］ 肖军，唐发宽，王龙. 前壁导联ST段压低与急性下壁心肌梗死冠脉病变状况及预后的关系［J］. 心脏杂志， 2007, 19(3):318-325.

［3］ Kontos MC, Desai PV, Jesse RL, et al. Usefulness of the admission eletrocardiogram for identifying the infarctrelated artery in inferior wall acute myocardial infarction［J］. Am J Cardiol, 1997, 79(2):182-184.

［4］ Birnbaum Y, Herz I, Sclarousky S, et al. Prognostic significance of precordial ST segment depression on admission electrocardiogram in patients with inferior wall myocardial infarction［J］. J Am Coll Cardiol, 1996, 28(2):313-318.

［5］ 田乃亮,陈绍良,周陵,等. 不同的梗死相关血管急性下壁心肌梗死特点［J］. 中华急诊医学杂志, 2007, 16(4):366-368.

［6］ 吴元,陈纪林,高润霖,等. 急性下壁心肌梗死伴胸前导联ST段下降的临床意义［J］. 中国循环杂志, 1998, 13(4):140-141.

［7］ Assali A, Gilad I, Herz I, et al. Atrial natriuretic peptide levels after different types of inferior wall myocardial infarction［J］. Clin Cardiol, 1997, 20(8):717-722.

［8］ 吴少琴，卢益中，黄海萍. 急性下壁心肌梗死伴胸前导联ST段压低患者的临床预后分析［J］. 心脏杂志， 2006, 18(2)：243.

备注/Memo

备注/Memo:
收稿日期：2008-2-21.作者简介：富路，主任医师Email：fulunadia@yahoo.com.cn
更新日期/Last Update: 2009-06-15