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目的探讨急性下壁心肌梗死(IAMI)患者胸前导联ST段改变与冠状动脉(冠脉)病变的关系。方法根据所选患者心电图胸前导联的ST段改变,将52例IAMI患者分为ST段正常组、ST段抬高组及ST段压低组,对所选患者进行选择性冠脉造影并比较各组患者冠脉病变情况。结果 ST段正常组18例,冠脉呈单支病变16例(88.9%),多支病变2例(11.1%);右冠脉远段病变10例。ST段抬高组13例,冠脉呈单支病变9例(69.2%),多支病变4例(30.8%);右冠脉近段病变6例,左前降支近段病变3例。ST段压低组21例,冠脉呈单支病变6例(28.6%),多支病变15例(71.4%);右冠脉远段病变11例,左前降支远段病变8例,回旋支远段病变6例(多支病变时,例数计算有重叠)。结论 IAMI伴胸前导联ST段压低者多提示冠脉多支病变,且远段病变多见;ST段抬高者多提示右冠脉及左前降支近段病变。
Objective To investigate the relationship between ST-segment changes in coronary antrum (coronary artery) and coronary artery lesions in patients with acute inferior myocardial infarction (IAMI). Methods According to the changes of ST segment in the selected chest ECG, 52 patients with IAMI were divided into ST-segment normal group, ST-segment elevation group and ST-segment depression group. The patients underwent selective coronary angiography and compared Coronary lesions in each group. Results There were 18 cases with normal ST segment, 16 cases with single coronary artery disease (88.9%), 2 cases with multi-vessel disease (11.1%), and 10 cases with distal coronary artery disease. Thirteen patients with ST segment elevation showed coronary artery single vessel disease in 9 cases (69.2%), multiple vessel disease in 4 cases (30.8%), right coronary artery proximal lesion in 6 cases and left anterior descending artery proximal segment in 3 cases. ST-segment depression in 21 cases, coronary artery was single vessel disease in 6 cases (28.6%), multivessel disease in 15 cases (71.4%); right coronary artery distal lesions in 11 cases, left anterior descending branch distal lesions in 8 cases, 6 cases of distal lesions (multi-vessel disease, the number of cases overlap). Conclusions IAMI with ST-segment depression in the anterior thoracic leads are suggestive of multi-vessel coronary artery disease, and distal lesions are more common. Most of the patients with ST-segment elevation suggest proximal lesions of the right coronary artery and left anterior descending artery.