246例回旋支不同节段闭塞的心电图特点

目的探讨回旋支闭塞中不同节段,不同优势型,多支病变对心电图变化的影响。方法本研究共入选246例发生急性LCX闭塞的患者（其中男187例,女59例）,根据冠脉造影结果将患者根据冠脉优势型、单支、多支、合并LAD、RCA分组,结合年龄、性别及相关危险因素,对比分析心电图改变与冠脉造影结果及临床特点的关系。结果回旋支闭塞心电图变化受不同冠脉优势型影响,Ⅱ、Ⅲ、aVF、V7~V9导联ST段抬高常见于左优势型的LCX闭塞。V1~V3导联ST段压低常见于均衡型的LCX闭塞,Ⅰ、aVL导联ST段抬高在各优势型中无特异性。在单支LCX闭塞中,V1~V3导联ST段压低常见于近段闭塞,Ⅱ、Ⅲ、aVF导联ST段抬高常见于远段闭塞,V7~V9导联ST段抬高与Ⅰ、aVL导联ST段抬高在各节段闭塞的心电图中无特异性。合并多支病变时LCX心电图变化与单纯LCX闭塞存在差异,在LCX近段闭塞中,合并多支病变的患者更易出现V7~V9导联ST段抬高,单支病变者心电图易出现V1~V3导联ST段压低,在LCX中段闭塞的患者中,单支病变与多支病变的心电图改变大致相同。在LCX远段闭塞的患者中,多支病变患者出现V1~V3导联ST段压低可能性较大。OM闭塞在单支及合并多支病变时的心电图差异无明显统计学意义。在合并LAD或RCA病变的LCX闭塞患者中,心电图改变无明显差异。结论心电图对诊断梗死相关动脉为回旋支的急性心肌梗死有重要的预测价值,结合病史及相关一般资料可对急性心肌梗死患者的预后进行评估。

Electrocardiographic features of 246 patients with occlusion of different segments of the left circumflex coronary artery

Objective To investigate the electrocardiographic features in occlusion of different segment of the left circumflex coronary artery,multivessel disease and different dominant coronary types.Methods A total of 246 patients with acute occlusion of left circumflex coronary artery （187 males and 59 females） were recruited for the study.According to the results of coronary angiography,we grouped the patients with multi/single vessel disease,complicated by LAD/RCA,combined by age,sex and risk factors.We compared ECG changes and results of coronary angiography.Results The ECG changes of circumflex artery occlusion affected by different dominant coronary types,in Ⅱ,Ⅲ,aVF,V7～V9 leads,ST segment elevation is common in left dominant type.V1～V3 lead ST segment depression is common in the balanced type,Ⅰ,aVL lead ST segment elevation is non-specific in all the advantages of type.In single vessel disease,V1～V3 lead ST segment depression are common in proximal occlusion,Ⅱ,Ⅲ,aVF lead ST segment elevation are common in the distal occlusion,V7～V9 and Ⅰ,aVL leads ST segment elevation are non-specific in single vessel disease.There are difference features in ECG about single vessel disease and multi-vessel disease,in the proximal LCX occlusion,patients with multi-vessel disease more likely to merge V7～V9 lead ST segment elevation,in middle LCX occlusion,there are non-specific change in single or multi vessel disease,and patients with V1～V3 lead ST segment depression are more likely to merge multi-vessel disease.Patient with LCX occlusion complicated with LAD/RCA have no significant difference in ECG.Conclusions ECG has important value in diagnosis of the infarct-related artery circumflex artery in acute myocardial infarction,we can assess the prognosis of patients with acute myocardial infraction combined the patients combined the history and general information.