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目的探讨急性右心室心肌梗塞(ARVI)的临床特征、诊断及治疗要点,提供对其特殊性的认识。方法对40例急性ARVI患者临床资料进行分析。结果与结论患者多有基础疾病,多有诱发因素,具有一般急性心肌梗塞的症状,常合并其他部位心肌梗塞,体征主要是低血压、颈静脉充盈、三尖瓣关闭不全的收缩期杂音、右心功能不全、心源性休克、心律失常。全部心电图均有V4R导联ST段抬高,52.1%抬高超过RV1-V3导联ST段。18例行UCG检查,均表现为右心室扩大及右心室壁节段性运动异常。治疗上要重视扩溶升压,慎用血管扩张剂,不用硝酸甘油、利尿剂及强心洋地黄药物,20例行溶栓治疗,38例症状缓解,血流动力学稳定,2例死于全心衰竭,抢救成功率95%。
Objective To investigate the clinical features, diagnosis and treatment of acute right ventricular myocardial infarction (ARVI) and to provide some insight into its particularity. Methods The clinical data of 40 patients with acute ARVI were analyzed. RESULTS AND CONCLUSIONS Patients had more underlying diseases, more predisposing factors, symptoms of general acute myocardial infarction, and often complicated with myocardial infarction in other areas. The signs were mainly hypotension, filling of jugular vein, systolic murmur of tricuspid regurgitation, Cardiac insufficiency, cardiogenic shock, arrhythmia. All electrocardiograms showed ST segment elevation of V4R lead, and elevation of 52.1% exceeded ST segment of RV1-V3 lead. 18 cases of UCG examination showed both right ventricular enlargement and segmental right ventricular wall motion abnormalities. Treatment should pay attention to the expansion of vasopressor, caution with vasodilators, no nitroglycerin, diuretics and cardiac digoxin drugs, 20 cases of thrombolytic therapy, 38 patients with symptomatic relief, hemodynamic stability, 2 patients died of Heart failure, rescue success rate of 95%.