急性心肌梗死時體表心電圖預(yù)測左主干閉塞的臨床意義.pdf
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急性心肌梗死時體表心電圖預(yù)測
左主干閉塞的臨床意義
宮力紅1
趙維連1
張大鵬1
徐立1
葛永貴1
王紅石1
王樂豐1
楊新春1
[摘要] 目的:分析急性冠狀動脈左主干(LM)閉塞的常規(guī)心電圖( ECG)表現(xiàn) ,總結(jié)其 ECG特點(diǎn)。方法:15
例急性心肌梗死(AMI)患者經(jīng)冠狀動脈造影證實(shí)為急性LM 閉塞(LM 組) ,回顧性分析其急診 ECG表現(xiàn)。并選
取同時期 30 例左前降支(LAD)近段閉塞的 AMI患者(LAD組) ,比較 2 組造影前的急診 ECG表現(xiàn) ,以求總結(jié)急
性LM 閉塞的常規(guī) ECG特點(diǎn)。結(jié)果:LM 組心率快于LAD 組 ,心律失常發(fā)生率 2 組差異無統(tǒng)計學(xué)意義。LM 組
中 13 例患者存在 aVR導(dǎo)聯(lián) ST 段抬高( ≥0. 05 mV) ,發(fā)生率明顯高于 LAD 組(分別為 8617 %和 3617 % , P <
0101) ,同時LM 組 aVR導(dǎo)聯(lián) ST段抬高幅度亦明顯大于LAD組。而LM 組胸前導(dǎo)聯(lián) V1～3的 ST段抬高程度則
明顯低于LAD組。aVR導(dǎo)聯(lián) ST段抬高 > 0105 mV 診斷急性 LM 閉塞的敏感性為 90 % ,特異性為 6313 %。如
果同時再滿足 V1～3導(dǎo)聯(lián) ST段抬高程度 < 015 mV ,其診斷急性 LM 閉塞的敏感性為 90 % ,特異性達(dá)到 8617 %。
結(jié)論:aVR導(dǎo)聯(lián) ST段抬高 ≥0105 mV ,同時伴有 V1～3導(dǎo)聯(lián) ST 段抬高不明顯、 甚至壓低是急性 LM 閉塞區(qū)別于
LAD閉塞的 ECG特點(diǎn) ,結(jié)合臨床表現(xiàn) ,分析 ECG特點(diǎn)可能有助于造影前預(yù)測此類患者和進(jìn)行風(fēng)險評價。
[關(guān)鍵詞] 心肌梗死;冠狀動脈狹窄;心電描記術(shù)
[中圖分類號] R543. 1 [文獻(xiàn)標(biāo)志碼] A [文章編號] 100121439 (2008) 0220111203
Electrocardiographic characteristics in patients with acute myocardial
infarction associated with lef t main artery obstruction
GON G L i hong Z HAO Wei l i an Z HA N G Da pen g XU L I
GE Yong g ui WA N G Hon gshi WA N G L e f eng YA N G X i nchun
(Department of Cardiology , Beijing Chaoyang Ho spital , Cardiovascular Instit ute , Capital Uni2
ver sity of Medical Science , Beijing , l00020 , China)
Abstract Objective :The elect rocardiograms in patient s with AMI associated with lef t main (LM) artery ob2
st ruction were analyzed ret rospectively to determine the elect rocardiographic features in this group of patient s.
Method :From J an 1999 to J une 2007 ,acute LM obst ruction were confirmed in 15 patient s with AMI by emergency
coronary angiography. The emergency elect rocardiograms before angiography in these 15 patient s (LM group) were
analyzed ret rospectively , and their elect rocardiographic features were compared with those in 30 patient s with AMI
resulted f rom proximal lef t anterior descending artery obst ruction ( LAD group ) . Result : There was no significant
1
首都醫(yī)科大學(xué)附屬北京朝陽醫(yī)院心臟中心(北京 ,100020)
通訊作者:宮力紅 ,E2mail :66jinlang @163. com
參考文獻(xiàn)
[1 ] 王黎明 ,祁國榮.青海省先天性心臟病介入治療現(xiàn)狀
與展望[J ] . 中國醫(yī)學(xué)文摘外科學(xué)分冊 ,2006 ,15 (增
刊) :108 - 110.
[2 ] 蔣世良 ,黃連軍 ,徐中英 ,等.心臟病介入治療的嚴(yán)重
并發(fā)癥分析及其防治[J ] .中國循環(huán)雜志 ,2001 ,16 (增
刊) :22 - 24.
[3 ] CAO Q L , DU Z D , JOSEPH A , et al . Immediate
and six2month result s of the profile of the Amplatzer
septal occluder as assessed by t ransesophageal echo2
cardiography[J ] . Am J Cardiol , 2001 ,88 :754 - 759.
[4 ] 王廣義 ,王峙峰 ,郭軍 ,等. 經(jīng)導(dǎo)管介入封堵老年繼發(fā)
孔型房間隔缺損[J ] . 心臟雜志 ,2004 ,16 (21) : S71 -
72.
[5 ] 楊軍 ,曉踐明 ,郭濤 ,等.心臟介入性治療致急性心臟
壓塞 4 例[J ] .臨床心血管病雜志 ,2005 ,21 (4) :245 -
245.
[6 ] 王世勛 ,趙令時.室間隔介入封堵術(shù)后并發(fā)一過性高
度房室傳導(dǎo)阻滯 1 例[J ] .臨床心血管病雜志 ,2005 ,21 (8) :500 - 500.
[7 ] 湛守青 ,祁秉文 ,祁國榮 ,等.高原地區(qū)動脈導(dǎo)管未閉
封堵術(shù)后溶血 1 例報告[J ] . 實(shí)用放射學(xué)雜志 ,2004 ,220 (4) :349 - 349.
[8 ] 戴汝平 ,劉延玲 ,張戈軍 ,等. 應(yīng)用 Amplatzer 封堵器
介入治療房間隔缺損療效評價[J ] . 中華心血管病雜
志 ,2000 ,28 (2) :87 - 92.
(收稿日期:2007203214)
· 111 · 臨床心血管病雜志2008 年2 月第24 卷第2 期difference in occurrence of arrhythmia between the two groups. Heart rate in the LM group was higher than that in
the LAD group. The occurrence rate and degree of ST segment elevation in lead aVR were both significantly high2
er in the LM group compared with the LAD group. The degree of ST segment elevation in lead V1 , V2 and V3
were also lower in the LM group compared with the LAD group . ST elevation in aVR predicted LM obst ruction
with sensitivity of 90 % and specificity of 6313 %. Both ST elevation in aVR ( > 0105 mV) and minor ST elevation
in V1～3 (total level < 015 mV) represented lef t main obst ruction with sensitivity of 90 % and specificity of 8617 %.
Conclusion :ST elevation in aVR with minor ST elevation in V1～3 is an important predictor of acute lef t main artery
obst ruction.
Key words Myocardial infarction ; Coronary stenosis ; Elect rocardiography
急性冠狀動脈左主干(LM)閉塞導(dǎo)致的急性心
肌梗死(AMl)患者病情兇險 ,病死率高 ,大部分患
者可能沒有機(jī)會到達(dá)醫(yī)院接受冠狀動脈造影
(CA G)確診 ......
左主干閉塞的臨床意義
宮力紅1
趙維連1
張大鵬1
徐立1
葛永貴1
王紅石1
王樂豐1
楊新春1
[摘要] 目的:分析急性冠狀動脈左主干(LM)閉塞的常規(guī)心電圖( ECG)表現(xiàn) ,總結(jié)其 ECG特點(diǎn)。方法:15
例急性心肌梗死(AMI)患者經(jīng)冠狀動脈造影證實(shí)為急性LM 閉塞(LM 組) ,回顧性分析其急診 ECG表現(xiàn)。并選
取同時期 30 例左前降支(LAD)近段閉塞的 AMI患者(LAD組) ,比較 2 組造影前的急診 ECG表現(xiàn) ,以求總結(jié)急
性LM 閉塞的常規(guī) ECG特點(diǎn)。結(jié)果:LM 組心率快于LAD 組 ,心律失常發(fā)生率 2 組差異無統(tǒng)計學(xué)意義。LM 組
中 13 例患者存在 aVR導(dǎo)聯(lián) ST 段抬高( ≥0. 05 mV) ,發(fā)生率明顯高于 LAD 組(分別為 8617 %和 3617 % , P <
0101) ,同時LM 組 aVR導(dǎo)聯(lián) ST段抬高幅度亦明顯大于LAD組。而LM 組胸前導(dǎo)聯(lián) V1～3的 ST段抬高程度則
明顯低于LAD組。aVR導(dǎo)聯(lián) ST段抬高 > 0105 mV 診斷急性 LM 閉塞的敏感性為 90 % ,特異性為 6313 %。如
果同時再滿足 V1～3導(dǎo)聯(lián) ST段抬高程度 < 015 mV ,其診斷急性 LM 閉塞的敏感性為 90 % ,特異性達(dá)到 8617 %。
結(jié)論:aVR導(dǎo)聯(lián) ST段抬高 ≥0105 mV ,同時伴有 V1～3導(dǎo)聯(lián) ST 段抬高不明顯、 甚至壓低是急性 LM 閉塞區(qū)別于
LAD閉塞的 ECG特點(diǎn) ,結(jié)合臨床表現(xiàn) ,分析 ECG特點(diǎn)可能有助于造影前預(yù)測此類患者和進(jìn)行風(fēng)險評價。
[關(guān)鍵詞] 心肌梗死;冠狀動脈狹窄;心電描記術(shù)
[中圖分類號] R543. 1 [文獻(xiàn)標(biāo)志碼] A [文章編號] 100121439 (2008) 0220111203
Electrocardiographic characteristics in patients with acute myocardial
infarction associated with lef t main artery obstruction
GON G L i hong Z HAO Wei l i an Z HA N G Da pen g XU L I
GE Yong g ui WA N G Hon gshi WA N G L e f eng YA N G X i nchun
(Department of Cardiology , Beijing Chaoyang Ho spital , Cardiovascular Instit ute , Capital Uni2
ver sity of Medical Science , Beijing , l00020 , China)
Abstract Objective :The elect rocardiograms in patient s with AMI associated with lef t main (LM) artery ob2
st ruction were analyzed ret rospectively to determine the elect rocardiographic features in this group of patient s.
Method :From J an 1999 to J une 2007 ,acute LM obst ruction were confirmed in 15 patient s with AMI by emergency
coronary angiography. The emergency elect rocardiograms before angiography in these 15 patient s (LM group) were
analyzed ret rospectively , and their elect rocardiographic features were compared with those in 30 patient s with AMI
resulted f rom proximal lef t anterior descending artery obst ruction ( LAD group ) . Result : There was no significant
1
首都醫(yī)科大學(xué)附屬北京朝陽醫(yī)院心臟中心(北京 ,100020)
通訊作者:宮力紅 ,E2mail :66jinlang @163. com
參考文獻(xiàn)
[1 ] 王黎明 ,祁國榮.青海省先天性心臟病介入治療現(xiàn)狀
與展望[J ] . 中國醫(yī)學(xué)文摘外科學(xué)分冊 ,2006 ,15 (增
刊) :108 - 110.
[2 ] 蔣世良 ,黃連軍 ,徐中英 ,等.心臟病介入治療的嚴(yán)重
并發(fā)癥分析及其防治[J ] .中國循環(huán)雜志 ,2001 ,16 (增
刊) :22 - 24.
[3 ] CAO Q L , DU Z D , JOSEPH A , et al . Immediate
and six2month result s of the profile of the Amplatzer
septal occluder as assessed by t ransesophageal echo2
cardiography[J ] . Am J Cardiol , 2001 ,88 :754 - 759.
[4 ] 王廣義 ,王峙峰 ,郭軍 ,等. 經(jīng)導(dǎo)管介入封堵老年繼發(fā)
孔型房間隔缺損[J ] . 心臟雜志 ,2004 ,16 (21) : S71 -
72.
[5 ] 楊軍 ,曉踐明 ,郭濤 ,等.心臟介入性治療致急性心臟
壓塞 4 例[J ] .臨床心血管病雜志 ,2005 ,21 (4) :245 -
245.
[6 ] 王世勛 ,趙令時.室間隔介入封堵術(shù)后并發(fā)一過性高
度房室傳導(dǎo)阻滯 1 例[J ] .臨床心血管病雜志 ,2005 ,21 (8) :500 - 500.
[7 ] 湛守青 ,祁秉文 ,祁國榮 ,等.高原地區(qū)動脈導(dǎo)管未閉
封堵術(shù)后溶血 1 例報告[J ] . 實(shí)用放射學(xué)雜志 ,2004 ,220 (4) :349 - 349.
[8 ] 戴汝平 ,劉延玲 ,張戈軍 ,等. 應(yīng)用 Amplatzer 封堵器
介入治療房間隔缺損療效評價[J ] . 中華心血管病雜
志 ,2000 ,28 (2) :87 - 92.
(收稿日期:2007203214)
· 111 · 臨床心血管病雜志2008 年2 月第24 卷第2 期difference in occurrence of arrhythmia between the two groups. Heart rate in the LM group was higher than that in
the LAD group. The occurrence rate and degree of ST segment elevation in lead aVR were both significantly high2
er in the LM group compared with the LAD group. The degree of ST segment elevation in lead V1 , V2 and V3
were also lower in the LM group compared with the LAD group . ST elevation in aVR predicted LM obst ruction
with sensitivity of 90 % and specificity of 6313 %. Both ST elevation in aVR ( > 0105 mV) and minor ST elevation
in V1～3 (total level < 015 mV) represented lef t main obst ruction with sensitivity of 90 % and specificity of 8617 %.
Conclusion :ST elevation in aVR with minor ST elevation in V1～3 is an important predictor of acute lef t main artery
obst ruction.
Key words Myocardial infarction ; Coronary stenosis ; Elect rocardiography
急性冠狀動脈左主干(LM)閉塞導(dǎo)致的急性心
肌梗死(AMl)患者病情兇險 ,病死率高 ,大部分患
者可能沒有機(jī)會到達(dá)醫(yī)院接受冠狀動脈造影
(CA G)確診 ......
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