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目的探讨Rv5较Rv4波幅降低幅度和Rv4/Rv5比值指标,分析下壁合并后壁心肌梗死诊断价值及梗死病变动脉相关性。方法下后壁MI 270例(急性176例,陈旧性94例),单纯下壁MI 408例,健康人100例,均查同步12导联ECG,确定Rv4较Rv5波幅降低≥0.5mV及Rv4/Rv5≥1.5,对MI不同病程及冠脉造影相关动脉综合分析。结果Rv4波幅各组间差异无统计学意义(P>0.05),下后壁组Rv5降低0.40~0.49mV7例(2.6%),≥0.5mV263例(97.3%)。Rv4/Rv5≥1.5,急性期与陈旧性差异无统计学意义(P>0.05),但高于下壁和健康组(P<0.01),诊断后壁MI敏感性97.1%,特异性82.9%,准确度90.4%,阳性预测值94.4%,冠脉造影右冠脉病变为主,双支、三支病变多见(P<0.01)。结论Rv5振幅较Rv4降低≥O.5mV,Rv4/Rv5≥1.5与下后壁MI定位、病变范围累及梗死冠脉有关而与病程及时程无关。Rv5波幅降低越明显,Rv4/Rv5比值越大,对下壁合并后壁MI诊断率越高,为临床治疗STEAMI PCI和冠脉造影,开通梗死相关动脉提供依据。
Objective To investigate the ratio of Rv5 amplitude reduction and Rv4 / Rv5 ratio in Rv4 and analyze the diagnostic value of inferior wall combined with posterior wall myocardial infarction and the correlation of infarction artery. Methods: 270 cases of posterior wall MI 270 cases (acute 176 cases, old 94 cases), simple inferior wall MI 408 cases and healthy person 100 cases were examined synchronously with 12-lead ECG to determine Rv4 amplitude lower than Rv5 ≥ 0.5mV and Rv4 / Rv5≥1.5, on the different course of MI and coronary angiography related arteries comprehensive analysis. Results There was no significant difference in the amplitude of Rv4 between the groups (P> 0.05). In the posterior wall group, Rv5 decreased by 0.40 ~ 0.49mV in 7 cases (2.6%) and ≥0.5mV263 cases (97.3%). Rv4 / Rv5≥1.5, there was no significant difference between the acute phase and the old one (P> 0.05), but higher than the inferior wall and the healthy group (P <0.01). The sensitivity and specificity of posterior wall MI were 97.1% and 82.9% Accuracy 90.4%, positive predictive value 94.4%, coronary angiography right coronary artery lesions, double, three lesions more common (P <0.01). Conclusions The amplitude of Rv5 is lower than or equal to 0.5mV in comparison with Rv4. Rv4 / Rv5≥1.5 is related to the location of MI in inferior posterior wall and the extent of lesion is involved in infarcted coronary artery. Rv5 amplitude decreased more obvious, Rv4 / Rv5 ratio of the greater, the lower wall of the posterior wall MI diagnosis rate higher, for the clinical treatment of STEAMI PCI and coronary angiography, provide the basis for the opening of infarct-related arteries.