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目的探讨下壁导联异常Q波在诊断陈旧心肌梗死中的临床意义。方法选择心电图下壁导联出现异常Q波的患者,结合其病史及辅助检查,了解下壁导联异常Q波临床谱,明确与陈旧下壁心肌梗死的鉴别。结果选择2015年1月至2016年12月,我院门诊及住院患者心电图提示下壁异常Q波患者103例,平均年龄(57±2.3)岁。异常Q波的诊断标准:下壁连续2个导联Q波时限≥0.03s、Q波振幅≥0.1 mV。27例出现在Ⅱ、Ⅲ、a VF导联,61例出现在Ⅲ、a VF导联,15例仅出现在Ⅲ导联;9例QⅡ≥0.04s+Q/R≥1/4,24例伴ST-T改变,79例不伴ST-T改变。其中陈旧下壁心肌梗死患者21例,非心肌梗死患者82例。陈旧心肌梗死患者下壁导联均在Ⅱ导联出现异常Q波,9例患者心电图QⅡ≥0.04s+Q/R≥1/4均为陈旧性心肌梗死。结论下壁导联异常Q波是诊断陈旧下壁心肌梗死的重要线索,Ⅱ导联异常Q波支持陈旧心肌梗死的诊断,但异常Q波并非其唯一诊断线索,需要结合患者病史及心脏超声等影像学检查确诊。
Objective To investigate the clinical significance of abnormal inferior Q wave in the diagnosis of old myocardial infarction. Methods The patients with abnormal Q waves in the inferior leads of electrocardiogram were selected. Combined with their medical history and auxiliary examinations, the clinical spectrum of abnormal Q waves in the inferior leads was identified and the identification of obstructive inferior myocardial infarction was clarified. Results From January 2015 to December 2016, 103 outpatients and inpatients with electrocardiogram (ECG) suggestive of abnormal Q waves in inferior wall were included in this study. The mean age was 57 ± 2.3 years. Abnormal Q wave diagnostic criteria: the next two consecutive Q wall lead time ≥ 0.03s, Q wave amplitude ≥ 0.1 mV. 27 cases appeared in Ⅱ, Ⅲ, a VF leads, 61 cases appeared in Ⅲ, a VF leads, 15 cases only appeared in leads Ⅲ; 9 cases Q Ⅱ ≥ 0.04s + Q / R ≥ 1/4, 24 cases With ST-T changes, 79 cases were not associated with ST-T changes. Among them, 21 cases of obsolete inferior myocardial infarction and 82 cases of non-myocardial infarction. The inferior leads of the patients with old myocardial infarction had abnormal Q wave in Ⅱ lead, and the ECG of QⅡ≥0.04s + Q / R≥1 / 4 of 9 patients were all old myocardial infarction. Conclusion The anomalous Q wave of inferior leads is an important clue for the diagnosis of inferior myocardial infarction. The abnormal leads of Ⅱ lead support the diagnosis of old myocardial infarction. However, abnormal Q wave is not the only diagnostic clue, and needs to be combined with the patient’s history and echocardiography Imaging examination confirmed.