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目的：探讨下壁急性心肌梗死（AMI）的心电图对判断心肌梗死相关动脉和闭塞位置的作用。方法：对90例下壁AMI患者的心电图和冠状动脉造影资料进行分析。结果：①血管闭塞发生在右冠状动脉占87．8％，回旋支占12．2％，合并右心室心肌梗死（RVI）占41．4％。②下壁AMI右冠状动脉为心肌梗死相关动脉时，血管闭塞位置多发生在第1右心室支开口以远（73.8％），合并RVI时其闭塞多发生在第1右心室支开口前（64．9％）；下后壁伴侧壁AMI回旋支为心肌梗死相关动脉时，其闭塞位置均在钝缘支发出前。③下壁AMI时Ⅰ、aVL导联ST段呈对应性压低，提示右冠状动脉为心肌梗死相关动脉的敏感性为9.·5％，特异性为93．9％，ST段呈等电位线或轻度抬高，提示回旋支闭塞的敏感性为54.5％，特异性为75．0％。与传统RVI诊断相比ST段抬高幅度Ⅲ＞Ⅱ导联，提示RVI的敏感性为100．0％，特异性为49．3％。结论下壁AMI时心电图对判断梗死相关动脉和闭塞位置有重要的预测价值。
Objective: To investigate the role of electrocardiogram (ECG) of inferior wall acute myocardial infarction (AMI) in determining the position of artery and occlusion related to myocardial infarction. Methods: Electrocardiogram and coronary angiography data of 90 patients with inferior wall AMI were analyzed. Results: ①Vascular occlusion occurred in 87.8% of the right coronary artery and 12.2% of the circumflex artery, with 41.4% of patients with right ventricular myocardial infarction (RVI). (2) In the inferior wall AMI, the right coronary artery was infarction-related arteries, vascular occlusion occurred more frequently in the first right ventricular branch opening (73.8%), occlusion occurred more frequently in the first right ventricular branch opening .9%); the posterior wall of the inferior wall with the AMI circumflex artery myocardial infarction related to the occlusion of the location in the front margin of the blunt margin. ③ In inferior wall AMI, ST segment of aVL lead showed a corresponding decrease, suggesting that right coronary artery was sensitive to myocardial infarction artery was 9.5%, specificity was 93.9%, ST segment was isoelectric line Or slightly elevated, suggesting that the sensitivity of the circumflex artery occlusion was 54.5% and the specificity was 75.0%. Compared with the traditional diagnosis of RVI ST segment elevation amplitude Ⅲ> Ⅱ lead, suggesting that the sensitivity of RVI was 100.0%, specificity was 49.3%. Conclusions ECG in the inferior wall of AMI has an important predictive value in judging the location of infarction-related arteries and occlusions.