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目的结合冠状动脉造影结果,分析急性下壁心肌梗死患者心电图ST段改变的特征,探讨梗死相关动脉(IRA)的判定。方法选择197例急性下壁心肌梗死,其中右冠状动脉近段闭塞69例、右冠状动脉远段闭塞80例、回旋支(LCX)闭塞48例,患者胸痛发作12h内的心电图。结果三组以及导联间比较,右冠状动脉(RCA)闭塞可出现STaVR压低(p<0.05),同时STⅢ↑>STⅡ↑(p<0.05),STaVL压低较STI明显(p<0.05),与RCA闭塞的部位无关。结合三者,其预测RCA闭塞的敏感性84%、特异性90%、阳性预测值96%、阴性预测值60%。结论急性下壁心肌梗死早期除下壁导联ST抬高外,STⅢ↑>STⅡ↑、STaVL↓>STⅠ↓、STaVR↓提示RCA阻塞,是区别RCA闭塞或LCX闭塞的关键指标,对预后和决定是否采取血管重建治疗具有重要的参考价值。
Objective To analyze the characteristics of electrocardiographic ST segment changes in patients with acute inferior myocardial infarction (AMI) based on the results of coronary angiography and to explore the determination of infarct related artery (IRA). Methods A total of 197 patients with acute inferior myocardial infarction were selected, including 69 cases of proximal right coronary artery occlusion, 80 cases of distal right coronary artery occlusion, 48 cases of LCX occlusion and 12 hours electrocardiogram in patients with chest pain. Results STaVR depression (p <0.05), STⅢ ↑> ST Ⅱ ↑ (p <0.05) and STaVL depression were significantly lower than those of STI (p <0.05) RCA occlusion site has nothing to do. Combined with the three, its prediction of RCA occlusion 84% sensitivity, 90% specificity, positive predictive value of 96%, negative predictive value of 60%. Conclusions In the early stage of acute inferior myocardial infarction, except for ST elevation, ST Ⅲ ↑> STⅡ, STa ↓> STⅠ ↓ and STaVR ↓ suggest RCA occlusion, which is the key index to distinguish RCA occlusion or LCX occlusion. Whether to take the treatment of vascular reconstruction has important reference value.