急性前壁心肌梗死时下壁导联ST段改变的临床价值

目的探讨急性前壁心肌梗死病人下壁导联ST段改变的临床价值.方法对93例冠状动脉左前降支(LAD)单支病变所致急性前壁心肌梗死病人,根据早期心电图下壁导联ST段改变将其分为压低组、抬高组、无改变组3组,与冠状动脉造影结果进行分析比较.结果下壁导联ST段压低组中71.4%为LAD非包绕型近端病变;抬高组中61.5%为LAD包绕型远端病变;无改变组中LAD包绕型近端病变和LAD非包绕型远端病变所占比例相近.结论急性前壁心肌梗死病人下壁导联ST段改变与LAD形态及病变部位有关.     

急性前壁心肌梗死患者心电图下壁导联ST段改变与其冠状动脉病变的关系

目的　探讨急性前壁心肌梗死患者心电图下壁导联 ST段改变与冠状动脉病变的关系。方法　对 81例冠状动脉左前降支 (L AD)单支病变所致急性前壁心肌梗死患者 ,依其早期心电图下壁导联 ST段改变的形态将患者分为 3组 ,即压低组、抬高组、无改变组 ,并与冠状动脉造影结果进行比较和分析。结果　下壁导联 ST段压低组中73.3%患者为 L AD非优势近端病变 ;抬高组中 6 2 .5 %患者为 L AD优势远端病变 ;无改变组中 L AD优势近端病变与 L AD非优势远端病变所占比例近似。结论　急性前壁心肌梗死患者下壁导联 ST段改变与 L AD形态及病变的部位有关。     

急性前壁心肌梗死下壁导联ST段变化与前降支形态和梗死部位的关系

目的探讨急性前壁心肌梗死时下壁导联ST段的变化与不同前降支形态和梗死部位关系。方法根据下壁导联心电图ST段改变情况,将67例首发急性前壁心肌梗死病例分为ST段压低组,ST段抬高组和ST段无变化组,与冠状动脉造影结果对照,分析各组心电图变化与前降支形态和梗死部位的关系。结果梗死相关部位在前降支近端者ST段压低组中占81.25%,ST段抬高组占20%,ST段无变化组占46.34%(P<0.01);LAD返折支配1/4以上下壁在ST段压低组中占6.25%,ST段抬高组占70%,ST段无变化组占29.27%(P<0.01)。结论急性前壁心肌梗死时下壁导联ST;段变化与前降支梗死部位和形态有关。下壁导联ST段压低提示前降支近端梗死,ST段抬高提示前降支远端梗死且存在前降支返折。     

肢体导联ST段改变对急性前壁心肌梗死患者冠脉闭塞部位的预测价值

目的：结合冠状动脉造影结果分析肢体导联ST段改变对判断急性前壁心肌梗死患者冠脉闭塞部位的预测价值。方法入选84例因急性前壁梗死行冠状动脉造影检查的患者,对其发病后心电图肢体导联ST段改变的情况进行分析。结果冠状动脉造影发现,前降支近端病变（伴或不伴远端病变）,肢体导联Ⅱ、Ⅲ、aVF多表现为ST段压低≥0．1 mV;前降支远端病变（不伴近端病变）,肢体导联Ⅱ、Ⅲ、aVF的ST段多表现为抬高或无明显压低。结论对于急性前壁心肌梗死患者,心电图肢体导联ST段改变可以预测冠状动脉闭塞部位,对早期诊断和治疗方案选择有一定的指导意义。     

急性前壁心肌梗死伴不同下壁导联ST段改变的临床特点

目的探讨ST段抬高急性前壁心肌梗死(简称心梗)伴不同下壁导联ST段改变患者的梗死相关血管以及梗死面积及心功能情况。方法73例急性前壁心梗患者,根据入院时心电图下壁导联ST段改变情况将患者分为3组:A组为Ⅱ、Ⅲ、aVF中至少两个导联ST段抬高;B组为Ⅱ、Ⅲ、aVF中至少两个导联ST段压低,C组为Ⅱ、Ⅲ、aVF中少于两个导联ST段有改变。比较三组CK最大值,左室射血分数以及梗死相关血管(IRCA)。结果CK最大值3组比较A组最低(1280±531IU/Lvs2034±911,1677±630IU/L,P<0.01);左室射血分数A组最高(0.54±0.09vs0.48±0.07,0.47±0.08,P<0.01);三组IRCAA组中85.7%的患者位于“绕过心尖的左前降支(LAD)”的中远段,有14.3%的患者位于右冠状动脉(RCA)的近段;B组的患者中全部为非“绕过心尖的LAD”,其中有70.4%的患者位于非“绕过心尖的LAD”的近段;C组中有96.7%的患者为非“绕过心尖的LAD”,其中有73.3%的患者位于非“绕过心尖的LAD”的近中段,三组比较差异有显著性(P<0.01)。结论IRCA为LAD的急性前壁心梗时下壁ST段改变可能与LAD长度和病变部位有关;前壁合并下壁ST段同时抬高的患者若IRCA为“绕过心尖的LAD”,其梗死面积较小,心功能较好。     

急性前壁心肌梗死心电图ST段改变与前降支阻塞部位关系的研究

目的探讨急性前壁心肌梗死心电图的ST段改变与冠状动脉阻塞部位的关系。方法对34例急性前壁心肌梗死病人进行回顾性分析。结果34例患者中19例为前降支病变,15例为前降支合并多支血管病变,心电图STⅠ、aVL抬高,STⅡ、Ⅲ、aVF压低,STaVL>STⅠ,STV2>STaVR,STV3/Ⅱ<-2.3,均为前降支近端狭窄,STⅡ、Ⅲ、aVF、V5、V6抬高,STV5>STⅡ,STV6>STaVF,均为前降支远端狭窄。结论急性前壁心肌梗死病人进行心电图常规检查,可以预测梗死与冠状动脉阻塞部位的关系。STⅠ、aVL抬高,Ⅱ、Ⅲ、aVF压低>1mm,为前降支近端病变。Ⅱ、Ⅲ、aVF、V5、V6抬高>1mm为前降支远端病变。     

急性前壁心肌梗死时下壁导联ST段压低的临床意义

目的 :探讨急性前壁心肌梗死合并下壁导联 ST段压低的临床意义。方法 :回顾性分析2 2例首发急性前壁心肌梗死患者的心电图、冠状动脉及左室造影资料。结果 :急性前壁心肌梗死时下壁导联 ( 、 、a VF) ST段下移≥ 0 .0 5 m V组与 <0 .0 5 m V组的 、a VL导联 ST80 值有显著性差异 ( P <0 .0 5 ) ;两组的左前降支 6段 ( LAD6 )或 LAD始部病变的发生率也有显著性差异 ( P <0 .0 5 ) ;下壁导联 ST段压低≥ 0 .0 5 m V对 L AD6 或 LAD始部病变预测价值的敏感性及特异性分别是 : 导联 5 9%、5 0 % ; 导联 83%、70 % ;a VF导联 83%、70 %。结论 :急性前壁心肌梗死时下壁导联ST段压低预示 LAD6 或 L AD始部病变是高前侧壁发生透壁性心肌缺血的“镜像”反应 ,表现为 、a VL导联 ST段抬高 ;它与右冠状动脉、左旋支、多支病变以及胸前导联 ST段抬高程度无关     

急性下壁心肌梗死患者心电图胸前导联ST段改变的临床意义

目的探讨急性下壁心肌梗死患者心电图胸前导联ST段改变与冠状动脉造影(CAG)所见冠状动脉病变部位的关系及其临床意义。方法 187例急性下壁心肌梗死患者,按入院时18导心电图胸前导联ST段改变分为3组,ST段无变化组(47例),ST段抬高组(16例),ST段压低组(124例);所有患者均行CAG。结果急性下壁心肌梗死伴胸前导联ST段抬高时多为右冠状动脉(RCA)近段闭塞(14例,82.3%),尤其是伴圆锥支动脉闭塞,与RCA中远端闭塞(2例,5.9%)比较差异有统计学意义(P0.01),且14例(73.7%)伴有右心功能不全和血流动力学障碍。下壁心肌梗死胸前导联ST段压低者可见于RCA、回旋支(LCX)闭塞及RCA、LCX闭塞与前降支(LAD)、对角支(D)病变的不同组合,其中LCX闭塞伴RCA病变者多表现为朐前ST V_4～V_6的压低,RCA闭塞伴LAD近端病变多有胸前ST V_1～V_6的压低,RCA伴D病变胸前ST V_1～V_3压低,与对照组比较差异有统计学意义(P0.05)。结论急性下壁心肌梗死合并胸前导联ST段抬高表明为RCA近段或丌口闭塞且多伴右心室心肌梗死和心功能不全;下壁心肌梗死伴胸前导联ST段压低提示为多支病变,ST V_1～V_3压低多伴有对角支严重狭窄,STV_1～V_6压低多伴有前降支的严重狭窄。     

常规心电图对前壁下壁心肌梗死罪犯血管的预测价值

目的:分析常规心电图对急性前壁下壁心肌梗死罪犯血管的预测价值。方法:选择41例急性前壁合并下壁ST段抬高的心肌梗死者作为研究对象,按冠脉造影资料将梗死罪犯血管分为右冠病变(RCA)组24例和左前降支病变(LAD)组17例,分别测量常规心电图12导联ST段偏移程度及发生的导联数,以计算比较两组间的差异及对不同冠脉之间的预测价值。结果:(1)两组的基线临床资料无显著差异性;(2)RCA组Ⅱ、Ⅲ、aVF导联ST段抬高幅度总和高于LAD组[(2.46±1.24)vs(1.77±0.61)mm,P0.01],ST段抬高III/II1(66%vs 28%,P0.01)或V1/V31(75%vs 12%,P0.05)在RCA组高于LAD组;LAD组V3导联ST段抬高幅度总和高于RCA组[(1.60±0.36)vs(4.44±2.65)mm,P0.01)。结论:Ⅱ、Ⅲ、aVF、V3导联ST段抬高幅度总和及V1/V3比值在诊断急性下壁前壁心肌梗死中对梗死罪犯血管有重要预测价值。     

急性前壁心肌梗死伴下壁导联ST段下移的临床意义

目的　探讨急性前壁心肌梗死患者入院时心电图下壁导联 ST段下移与临床预后及左冠状动脉前降支“罪犯”血管病变部位之间的关系。方法　选择 1998年 1月～ 2 0 0 2年 10月住院诊治并行冠状动脉造影的急性前壁心肌梗死患者 5 9例 ,依据冠状动脉造影所示左前降支“罪犯”血管病变部位与第一对角支起始部的关系分成两组 , 组 36例病变部位位于第一对角支发出前 , 组 2 3例病变位于第一对角支发出后。结果　 组 36例占 6 1.0 1% , 组 2 3例占 38.98%。 组病人多数合并下壁导联 ST段下移≥ 1mm ,在 、 、a VF导联分别为 81% ,92 % ,79%。 组多数 ST段位于等电位线或 ST段下移 <1m m,在 、 、a VF导联分别为 6 0 % ,6 1% ,5 3%。结论　急性前壁心肌梗死患者入院时心电图下壁导联 ST段下移可以预测“罪犯”血管病变部位位于第一对角支起始部近端 ,而 ST段位于等电位线或 ST段下移 <1mm预示病变部位位于前降支远端     

Significance of Q-wave regression after anterior wall acute myocardial infarction

Aims This study was conducted to clarify the significance of abnormalQ-wave regression in anterior wall acute myocardial infarction. Methods A total of 74 patients who presented with a first anterior wallacute myocardial infarction within 6h of onset were dividedinto two groups according to the presence (group A, n=29) orabsence (group B, n=45) of regression of abnormal Q waves. Regressionof abnormal Q waves was defined as the disappearance of theQ wave and the reappearance of the r wave 0·1mV in atleast one of leads I, aVL, and V₁to V₆. Results Emergency coronary arteriography revealed that group A had ahigher incidence of spontaneous recanalization or good collateralcirculation than group B (55% vs 31%,P<0·05). Peakcreatine kinase activity tended to be lower in group A thanin group B (2358±1796 vs 3092±1946IU.L^–1,P=0·09).Group A had a greater left ventricular ejection fraction andbetter regional wall motion at 1 and 6 months after acute myocardialinfarction than group B. The degree of improvement of left ventricularejection fraction and regional wall motion between 1 and 6 monthsafter acute myocardial infarction was significantly greaterin group A than in group B. Conclusion Patients with anterior wall acute myocardial infarction showingQ-wave regression had a trend towards a smaller amount of necroticmyocardium and a significantly larger amount of stunned myocardium.     

Comparison of segmental wall motion abnormalities on echocardiography in patients with anteroseptal versus extensive anterior wall ST-segment elevation myocardial infarction

Objective

Acute anteroseptal ST-segment elevation (STE) myocardial infarction (AS-STEMI), defined as STE limited to leads V1 to V3, has historically been associated with a smaller infarct size than extensive anterior STEMI (EA-STEMI), in which STE extends to leads V4 to V6. We compared the differences in global and regional wall motion by transthoracic echocardiography between patients with AS-STEMI and EA-STEMI.

Methods

Patients who presented with anterior STEMI and underwent primary percutaneous coronary intervention between January 2008 and March 2011 were included. For each subject, a transthoracic echocardiogram that was performed within 24 hours of admission was interpreted by an independent investigator blinded to the patient's electrocardiographic data.

Results

Of the 65 subjects who met our inclusion criteria, 30 had AS-STEMI and 35 had EA-STEMI. No differences were observed between groups in baseline characteristics or the mean number of hypokinetic, akinetic, and dyskinetic segments. Apical inferior segment dysfunction occurred more often in patients with EA-STEMI than in patients with AS-ASTEMI (71.4% vs 43.3%; P = .04). Distribution and extent of wall motion abnormalities were similar between patients with AS-STEMI and those with EA-STEMI.

Conclusion

The term AS-STEMI may be misleading, as it implies that only the anteroseptal segments are involved. We show that regional dysfunction in patients with AS-STEMI extends beyond the anteroseptal region.     

陈旧性广泛前壁心肌梗死介入干预后室壁运动的观察

目的　探讨介入干预能否使陈旧性广泛前壁梗死病人已梗死部分的室壁运动得到明显改善。方法　对1996年元月～ 1999年元月间在本院行PTCA或支架植入术的 5 0例陈旧性广泛前壁心肌梗死的病人采用中线腱法进行室壁运动分析。结果　分析结果显示 ,广泛前壁心肌梗死后前壁室壁活动存在明显的运动障碍。主要发生在 30～ 5 4腱区。Z值 - 2 79± 0 81。介入治疗后Z值为 - 2 81± 0 91。两者无明显差异 (P >0 0 5 )。结论　本结果表明 ,即使成功解除了梗死后相关冠状动脉的闭塞性病变 ,也并不能使广泛前壁梗死后存在明显运动减弱的心室壁活动有明显的改善     

Primary actinomycosis of the anterior abdominal wall: case report and review of the literature

Actinomycosis of the anterior abdominal wall is a rare infection caused by different Actinomyces species. We report a case of primary actinomycosis localized on the anterior abdominal wall, diagnosed by computed tomography (CT) scan, postoperatively confirmed by histopathological examination and treated by surgical resection combined with postoperative antibiotic therapy. The patient has been free of recurrence after 1 year. A review of the available literature is also presented.     

Results of chest wall resection and reconstruction in 162 patients with benign and malignant chest wall disease

Background

Chest wall resection is a complicated treatment modality with significant morbidity. The purpose of this study is to report our experience with chest wall resections and reconstructions.

Methods

The records of all patients undergoing chest wall resection and reconstruction were reviewed. Diagnostic procedures, surgical indications, the location and size of the chest wall defect, performance of lung resection, the type of prosthesis, and postoperative complications were recorded.

Results

From 1997 to 2008, 162 patients underwent chest wall resection.113 (70%) of patients were male. Age of patients was 14 to 69 years. The most common indications for surgery were primary chest wall tumors. The most common localized chest wall mass has been seen in the anterior chest wall. Sternal resection was required in 22 patients, Lung resection in 15 patients, Rigid prosthetic reconstruction has been used in 20 patients and nonrigid prolene mesh and Marlex mesh in 40 patients. Mean intensive care unit stay was 8 days. In-hospital mortality was 3.7 % (six patients).

Conclusions

Chest wall resection and reconstruction with Bone cement sandwich with mesh can be performed as a safe and effective surgical procedure for major chest wall defects and respiratory failure is lower in prosthetic reconstruction patients than previously reported (6).     

Myocardial bridging of the left anterior descending coronary artery in acute inferior wall myocardial infarction

BACKGROUND: We observed marked myocardial bridging of the left anterior descending coronary artery (LAD) in the acute stages of inferior wall myocardial infarction (MI) in a group of patients who developed shock despite successful reperfusion of the infarct-related lesion (IRL). HYPOTHESIS: The purpose of this study was to elucidate the clinical significance of myocardial bridging in patients with inferior wall MI and shock. METHODS: The study group consisted of 53 patients with single-vessel disease of the right coronary artery, who underwent coronary angiography for acute inferior wall MI. Clinical characteristics, coronary angiographic findings, and left ventricular function during the chronic phase were compared between the patients who developed shock (the shock group) and those who did not (the non-shock group). In addition, a multiple logistic analysis was performed to identify independent predictors of shock in patients with acute inferior wall MI. RESULTS: Reperfusion of the IRL was obtained in all 53 patients. The incidence of myocardial bridging of the LAD, the incidence of right ventricular MI, the peak creatine phosphokinase (CPK-MB). the pulmonary capillary wedge pressure, and the prevalence of pulmonary congestion seen on chest roentgenogram were significantly higher in the shock group than in the non-shock group. Myocardial bridging (p = 0.0018), right ventricular MI (p = 0.0374), and peak CPK-MB (p = 0.0189) were identified as independent predictors of shock in acute inferior wall MI. CONCLUSION: This study suggests that myocardial bridging plays a role in left ventricular function in the acute stage of inferior wall MI.     

新西兰兔实验性高前壁心肌坏死的Wilson和头胸导联的定位诊断

目的：比较新西兰兔实验性高前壁心肌坏死Wilson和头胸（head-chest,HC)导联的定位诊断。方法：采用冰乙酸化学腐蚀法复制高前壁心肌坏死的动物模型30只，记录心表心电图加以确认，再记录胸痛体表70点的ECG。根据病理性Q波出现和分布范围的不同，判断两种导联定位诊断的差异。结果：Wilson导联在胸痛部区域都记录到病理性Q波，而HC导联仅在胸部小范围内记录到病理性Q波，同一测试点两种导联记录到的病理性Q波的例数，经配对计数资料的x^2检验有显性差异（P＜0．05），同一试点H导联病Q波阳性率显少于Wilson导联。结论：Wilson导联记录到病理Q波的范围过于广泛，而HC导联则相对集中，与心肌坏死区域相当，故HC导联对于高前壁心肌坏死定位诊断的价值优于Wilson导联。