急性下壁心肌梗死胸前导联ST段改变的临床意义

目的分析急性下壁心肌梗死伴胸前导联ST段压低的临床意义。方法选择38例急性下壁心肌梗死患者常规心电图及24h动态心电图进行对照分析。结果急性下壁心肌梗死伴胸前导联ST段压低多于不伴胸前导联ST段压低(P<0.01);下壁伴正后壁心肌梗死伴胸前导联ST段压低多于不伴胸前导联ST段压低(P<0.01);下壁伴右心室心肌梗死与胸前导联ST段压低无明显关联(P<0.01);急性下壁心肌梗死伴胸前导联ST段压低者严重室性心律失常与房室传导阻滞的发生率较不伴胸前导联ST段压低者高(P<0.01)。结论急性下壁心肌梗死伴胸前导联ST段压低往往提示梗死范围大或同时存在心肌缺血、冠脉病变广泛、心功能损害较严重,并且严重室性心律失常与房室传导阻滞的发生率明显增高,心肌酶峰值明显增高临床预后较差。

Clinical implication of precordial ST segment depression in acute inferior myocardial infarction.

Objective To analyze clinical implication of precordial ST segment depression in acute inferior myocardial infarction (AIMI).Methods Routine electrocardiogram and 24 hours dynamic electrocardiogram were analyzed in 38 patients with acute inferior myocardial infarction.Results The number of patients with chest lead ST segment descent were more than that of patients without chest lead ST segment descent in patients with acute inferior myocardial infarction (P<0.01) and in patients with inferior wall and posterior wall acute myocardial infarction (P<0.01). However, there was no significant differences for chest lead ST segment descent between patients with or without inferior wall and right ventricle acute myocardial infarction(P>0.05). Incidence of serious ventricular arrhythmia and auricular-ventricular block in patients with chest lead ST segment descent was significantly higher (P<0.05).Conclusion Acute inferior myocardial infarction with chest lead ST segment descent indicate extensive infarction and/or myocardial ischemia, and severe coronary lesions and damage of cardiac function. The possibility of occurring serious ventricular arryhythmin and auricular-ventricular block is increased. Acute inferior myocardial infarction with chest lead ST segment descent is associated with bad prognosis.