体表心电图对急性下壁心肌梗死时梗死相关动脉的预测价值

目的：探讨冠状动脉单支病变所致急性下壁心肌梗死（AIMI）时，心电图对梗死相关动脉（IRA）为左回旋支动脉（LCX）或右冠状动脉（RCA）的预测价值。方法：分析ST段抬高型AIMI，IRA为单支LCX或RCA的冠状动脉造影资料及IRA开通前的心电图资料。观察心电图1及aVL导联、aVR导联、V1和V5、V6导联，ST段有无偏移基线，即抬高（T）或压低（1），并结合冠状动脉造影及临床资料，分析冠状动脉病变部位。结果：59例LCX或RCA单支病变引起的sT段抬高型AIMI中，LCX组7例，RCA组52例。在心电图判定指标中，RCA闭塞组sTI、aVLJ和STaVRf、无压低或压低〈0．1mV发生率均高于LCX闭塞组（P〈0．01和P〈0．05）；STaVR〉0．1mV、STV1和STV5、V6在LCX闭塞组中发生率均高于RCA闭塞组（P〈0．05）。STI、aVLj和STaVRt、无压低或压低〈0．1mV，预测RCA为IRA的敏感性分别为73．1％和80．8％，特异性分别为6／7和5／7。STV，0、STaVRiI〉0．1mV和sTV5及V。均抬高，预测LCX为IRA的敏感性分别是4／7、4／7和3／7，特异性分别为84．6％、86．5％和92．3％。结论：分析多个导联的心电图变化，应用多种方法组合预测AIMI的IRA，优于任一个单独的心电图标准。

The value of body-surface electrocardiogram in the prediction of the related artery of inferior wall acute myocardial infarction

Objective： To investigate the value of body-surface electrocardiogram in the prediction of acute inferior myocardial infarction（AIMI） caused by left circumflex artery（LCX） or right coronary artery（RCA）. Methods：The data of AIMI with ST segment elevation, coronary arteriography of LCX and IRA and the no-opening ECG were analyzed. The coronary artery lesion were determined by observing the ECG I ,aVL lead,aVR lead,V1 ,V5 and V6 lead and the baseline of ST segment（up or down） combined with analysing the coronary angiography and clinical data. Results ： During 59 AIMI cases with ST segment elevation caused by LCX or RCA lesion, 7 cases with LCX occlusion and 52 cases with RCA occlusion were found. The occurrence rates of ST I , aVL down ＆ ST aVR up and down to less than 0.1 mV or without in RCA occlusion patients were higher than those in LCX occlusion patients（ P 〈 0.01 and P 〈 0.05） ,the occurrence rates of ST aVR down more than or equal to 0.1 mV and ST Vt down,ST V5 ＆ ST V6 up in LCX occlusion patients were higher than those in RCA occlusion patients（ P 〈 0.05 ）. The sensitivity and specificity of ST V1 down ＆ ST aVR up and down to less than 0.1 mV or without in predicting RCA for infarct artery were 73.1% ＆ 80.8% and 6/7 ＆ 5/7, respectively. The sensitivity and specificity of ST Vl down,ST aVR down more than or equal to 0.1 mV and ST V5 ＆ ST V6 up in predicting LCX for infarct artery were 4/7,4/7 ＆ 3/7 and 84.6% , 86.5% ＆ 92.3% , respectively. Conclusions：The effects of analysing multiple lead changes of ECG and using various methods on predicting the related artery of inferior wall acute myocardial infarction are better than a single ECG standard.