作者单位: 100083北京市,北京大学第三医院心内科

    Email : niujie@medmail . com. cn

    ·临床研究·

    常规心电图对急性前壁心肌梗死时前降支

    闭塞部位预测价值的临床研究

    牛杰 孙丽杰 郭静萱 张萍 郭丽君 毛节明 陈明哲

    【摘要 】 目的 探讨急性前壁心肌梗死时的常规心电图 ( ECG)对前降支 (LAD)闭塞部位的预

    测价值。方法 根据冠状动脉造影的结果 ,以第一间隔支 ( S1 )为标志将患者分为 S1近端病变 ( PS)组

    (61例 )和 S1远端病变 (DS)组 (40例 )。分别测量常规 ECG 12导联 ST段的偏移程度及出现的频率 ,以计算、 比较两组之间的差异及其对近、 远段病变部位的预测性诊断价值。结果 (1)各导联诊断

    LAD近端病变的敏感性和特异性分别为: aVR导联 ST段抬高为 43%和 85% ( P = 01004) ; aVL导联

    ST段抬高 ≥115 mm为 16%和 97% ( P = 01031) ; Ⅱ导联 ST段下移 ≥110 mm为 39%和 85% ( P =

    01009) ; Ⅲ 导联 ST段下移 ≥210 mm为 23%和 98% ( P = 01005) ; aVF导联 ST段下移 ≥110 mm为

    38%和 88% (P = 01006) ;V5导联 ST段下移为 20%和 86% ( P = 01037) ; aVR导联 ST段抬高同时伴

    V5导联 ST段下移为 18%和 100% ( P = 01005) ; aVR导联 ST段抬高同时伴 V6导联 ST段下移为 30%

    和 93% ( P = 01008) ; (2)各导联诊断 LAD远端病变的敏感性和特异性分别为: Ⅲ 导联 ST段居于等电

    位线或抬高为 53%和 90% ( P = 01000) ;V5导联 ST段抬高 ≥115 mm为 50%和 82% (P = 01001) ; (3)

    近、 远端患者的梗死面积和心功能水平未见明显差异。结论 (1) aVR导联 ST段抬高同时出现 V5、V6导联 ST段下移;下壁导联 Ⅱ、 Ⅲ、 aVF导联 ST段明显下移 (Ⅱ, aVF导联 ST段下移 ≥110 mm, STⅢ

    下移 ≥210 mm)以及 Ⅰ, aVL导联 ST段抬高 ,尤其是 aVL导联 ST段抬高 ≥115 mm均提示 LAD近端

    病变。 (2)下壁导联 (尤其是 Ⅲ 导联 ) ST段居于等电位线或升高 ,V5导联 ST段抬高 ≥115 mm均提示

    LAD远端病变。

    【关键词 】 心肌梗死; 心电描记术; 冠状血管; 动脉硬化 , 闭塞型

    Precti ve va lue of electrocard i ogram in loca l i z ing the occlusi on site in the left an ter i or descend ing

    coronary artery i n acute an ter i or myocard i a l infarcti on N I U J ie, SUN L ijie, GUO J ingxuan, et al1

    D ivision of Cardiology, Pek ing Univer sity Third Hospital , B eijing 100083, China

    Em ail : niujie@m edm ail . com. cn

    【Abstract】 Objecti ve To evaluate the p redictive value of electr ocardi ogram in l ocalizing the

    occlusi on site in the left anteri or descending coronary artery (LAD) in acute anteri or myocardial infarcti on

    (AM I ) 1 Methods According t o the coronary angi ogram, all patients with AM I were divided int o t wo

    gr oup s: one ( the PS group) was a collecti on of patients ( n = 61) whose occlusi on siteswere p r oxi mal t o the

    first sep tal branch ( S1 ) and the other ( the DS gr oup) was a collecti on of patients ( n = 40) whose occlusi on

    site were distal t o S1 1 Diagnostic sensitivity and s pecificity in p redicti on of the occlusi on site in LAD were

    calculated based on the measurements and incidence of ST segments deviati on on electr ocardi ogram ( ECG) 1

    Results The sensitivity and specificity for p redicti on of occlusi on site being p roxi mal t o S1 in LAD using

    ECG were as foll ow: 43% and 85% ( P = 01004) for ST elevati on in lead aVR, 16% and 97% ( P =

    01031) for ST elevati on≥115 mm in lead aVL, 39% and 85% (P = 01009) for ST dep ressi on≥110 mm in

    lead Ⅱ, 23% and 98% ( P = 01005) for ST dep ressi on ≥210 mm in lead Ⅲ, 38% and 88% ( P = 01006)

    for ST dep ressi on ≥110 mm in lead aVF, 20% and 86% ( P = 01037) for ST dep ressi on in lead V5 , 18%

    and 100% ( P = 01005) for ST elevati on in lead aVR t ogether with ST dep ressi on in leads V5 , 30% and

    93% (P = 01008) for ST elevati on in lead aVR t ogetherwith ST dep ressi on in leadsV6 1 The sensitivity and

    s pecificity for diagnosis of occlusi on site being distal t o S1 were 53% and 90% ( P = 01000) ST elevati on or

    unchanged in lead Ⅲ, 50% and 82% ( P = 01001) for ST elevati on in lead V5 1There were no significant

    difference in infarcti on size and left ventricle ejecti on fracti on bet ween the t wo group s1 Conclusi on (1) ST ......