急性下壁ST段抬高心肌梗死直接冠脉内支架置入术靶血管判定及预后评估

目的 总结急诊介入治疗（PCI）的急性下壁心肌梗死患者心电图及临床资料,分析其对急性下壁心肌梗死患者罪犯血管判定及预后评估的作用.方法 选择2007年1月到2010年7月进行急诊PCI的急性下壁心肌梗死患者280例,根据冠脉造影结果分为右冠状动脉（RCA）梗死组及左冠回旋支（LCX）梗死组;根据临床结果分为高危急性下壁心梗组（高危组）及低危组.分析各组的心电图表现、危险因素及预后.结果 RCA组与LCX组比较,STⅢ＞STⅡ、STavL或STⅠ＞1 mm下移更多见于RCA梗死.高危组年龄比低危组偏大,糖尿病患者更多,更多出现心肌梗死溶栓治疗（TIMI）分级中的0级（无灌注）及1级（渗透而无灌注）,RCA近端闭塞及双支、三支病变患者,心电图出现STV3R-5R↑、STV7-V9↑、STV4-6↓、STV1↑、STAVR↓的比例更高.结论 心电图在急性下壁心肌梗死进行急诊PCI的患者诊断及预后判断中有重要作用,对进行急诊PCI靶血管判定有一定的协助作用.冠脉造影TIMI 0、1级,RCA近端闭塞,双支、三支病变患者,年龄偏大患者和糖尿病患者整体预后均较差.

The occluded infarct-related artery judgement and prognosis assessment in acute inferior wall ST-elevation myocardial infarction under primary percutaneous coronary intervention

Objective To analyze the clinical role of electrocardiogram and clinical data in acute inferior myocardial infarction who under primary percutaneous coronary intervention. Methods 280 subjectives with acute inferior myocardial infarction under primary percutaneous coronary intervention were enrolled, they were divided in- to two groups according to the coronary angiography results, right coronary artery （RCA） infarction group and left coronary circumflex artery （LCX） infarction group. According to the clinical results are divided into high-risk groups and low-risk groups. The risk factors and prognosis of each group were Analyzed. Results When compared in RCA group and LCX group, STⅢ 〉ST Ⅱ ,STavL or ST I 〉1 mm were more in RCA infarction, high-risk groups were older than low-risk groups, high-risk groups had more diabetes patients, thrombolysis in myocardial infarction （TIMI） 0,1 level, RCA proximal occlusion and double,three lesions, high-risk groups of patients with STv3R-5R↑ ,STw7-v9 ↑,STv4-6↓ ,STV1 ↑ ,STAwt ↓ were higher. Condusion Electrocardiogram plays an important role on the diagnosis and prognosis of acute inferior myocardial infarction under PCI, for occluded infarct-related artery judge it plays little assist role. The prognosis of patients who with coronary angiography TIMI grade 0, grade 1, RCA paroximal occlusion and double, three lesions, older diabetes is worse.