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急性心肌梗塞(AMI),尤其左室后壁梗塞时,是否右室受累,即右室梗塞,目前尚无特异性高的早期诊断方法。临床资料30例AMI症状出现后12h内住院患者。根据梗塞部位分3组:Ⅰ组9例左室后壁MI累及右室;Ⅱ组8例左室后壁梗塞、但未累及右室;Ⅲ组13例为前间壁、正前壁、侧壁梗塞。多数作者认为左室前壁梗塞一般不累及右室。右室梗塞的诊断是根据临床、心电图、超声心动图和右心导管测定的血流动力学改变确定。Ⅰ组死亡3例,尸检均有右室梗塞。Ⅱ组和Ⅲ组共死亡4例,尸检3例右室正常,1例右室小灶性坏死。全部病人均经右心导管取右房、右室以及周围静脉血测定肌酸激酶同功酶MB(MB)。若右室MB浓度高于右房则认为阳性,示有右室梗塞。结果Ⅰ组除1例有三尖瓣返流外,1例于病后5h时,测定MB为阴性(-1U/L),但于9h时,呈现阳性(5U/L)。余7例右室、右房MB梯度均为阳性(15.9±3.5U/L)。Ⅱ组-7.7±2.8U/L、
Acute myocardial infarction (AMI), especially left ventricular posterior wall infarction, right ventricular involvement, right ventricular infarction, there is no specific high early diagnosis. Clinical data 30 patients with AMI within 12h after onset of hospitalized patients. According to infarction site divided into 3 groups: Ⅰ group of 9 cases of left ventricular posterior wall MI involving the right ventricle; Ⅱ group of 8 cases of left ventricular posterior wall infarction, but did not involve the right ventricle; Ⅲ group of 13 cases of anterior wall, anterior wall, infarction. Most authors believe that left ventricular anterior infarction generally does not affect the right ventricle. Diagnosis of right ventricular infarction is based on clinical, electrocardiographic, echocardiographic, and right-heart catheterization hemodynamic determinations. Group Ⅰ died in 3 cases, autopsy had right ventricular infarction. There were 4 deaths in group Ⅱ and Ⅲ, 3 in normal autopsy and 1 in patients with right ventricular necrosis. All patients were measured right creatine catheter right atrium, right ventricular and peripheral venous blood creatine kinase MB (MB). If the right ventricular MB concentration higher than the right is considered positive, showing right ventricular infarction. Results In group Ⅰ, MB was negative (-1U / L) but positive at 5 hours (5U / L), except one case had tricuspid regurgitation. The other seven cases of right ventricular, right atrium MB gradient were positive (15.9 ± 3.5U / L). Ⅱ group -7.7 ± 2.8U / L,