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84例132支血管行经皮冠状动脉内血管成形术(PTCA),常规冠状动脉腔内心电图(IC—ECG)及体表心电图(S-ECG)进行术中监测。在气囊扩张时,S-ECG监测心肌缺血的阳性率为41.7％IC-ECG77.3％,缺血性ST段抬高幅度IC-ECG明显高于S-ECG(P<0.0000001)。缺血性心电图变化与首次PTCA扩张有密切关系。在(左)前降支动脉(LAD),左回旋支动脉(LCX)及右冠状动脉(RCA)行PTCA时,IC-ECG监测心肌缺血敏感性亦高于S-ECG监测,LAD p=0.000000,Lcxp<0.0002,RCA p<0.02。缺血发生时间,IC-ECG早于S-ECG。在PTCA时,IC-ECG及S-ECG结合对判断心肌缺血程度及判断预后有一定指导意义。S-ECG监测LAD及LCX敏感导联为V_2,其次为V_3;监测RCA的最好导联为Ⅱ导,其次为aVF导联。
Eighty-two patients underwent percutaneous transluminal coronary angioplasty (PTCA), conventional coronary artery endocardial electrogram (IC-ECG) and surface electrocardiogram (S-ECG). The positive rate of ischemic ST segment elevation was significantly higher than that of S-ECG (P <0.0000001) when S-ECG was used to detect myocardial ischemia at balloon dilatation. Ischemic ECG changes and the first PTCA expansion are closely related. The sensitivity of IC-ECG for monitoring myocardial ischemia was also higher than that of S-ECG monitoring in left (left) LAD, LCX, and RCA. LAD p = 0.000000, Lcxp <0.0002, RCA p <0.02. Ischemic time, IC-ECG was earlier than S-ECG. In PTCA, IC-ECG and S-ECG combined to determine the degree of myocardial ischemia and prognosis of a certain degree of guiding significance. S-ECG monitoring LAD and LCX-sensitive lead for V_2, followed by V_3; RCA monitoring the best lead for the lead, followed by aVF lead.