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目的探讨心电图对急性下壁心肌梗死相关冠脉的预测价值。方法根据冠状动脉造影证实的梗死相关冠脉结果,将153例急性下壁心肌梗死患者分为两组:右冠状动脉(RCA)闭塞组106例,回旋支(LCX)闭塞组47例。对两组患者心电图不同导联典型心肌梗死图形的发生率及ST-T改变发生率进行分析。结果RCA组STaVL↓>STl↓①、STIII↑>STII↑②、①+②、STaVF+V2>0的发生率均明显高于LCX组(x2=14.23,29.86,p<0.01),敏感性分别为75.8%、87.2%、70.9%、84.8%,特异性分别为83.9%、85.1%、100%、100%。LCX组①②两项均不具备、STaVF+V2<0的发生率明显高于RCA组(x2=42.43,49.26,p<0.01),敏感性分别为83.7%和94.0%,特异性均为100%。结论心电图STaVL↓>STl↓①、STIII↑>STII↑②、①+②、STaVF+Ⅴ2>0与①②两项均不具备、STaVF+V2<0对判断急性下壁心肌梗死的梗死相关动脉是RCA或LCX和闭塞位置有高度特异性,有重要的预测价值。
Objective To investigate the predictive value of electrocardiogram (ECG) in coronary artery associated with acute inferior myocardial infarction. Methods 153 patients with acute inferior myocardial infarction were divided into two groups according to coronary artery angiography confirmed coronary artery infarction: 106 cases of RCA occlusion group and 47 cases of LCX occlusion group. The incidences of typical myocardial infarction patterns and the incidence of ST-T changes in different leads of ECG in two groups of patients were analyzed. Results The incidences of STaVL ↓> STl ↓ ①, STIII ↑> STII ↑ ②, ① + ② and STaVF + V2> 0 in RCA group were significantly higher than those in LCX group (χ2 = 14.23,29.86, p <0.01) 75.8%, 87.2%, 70.9% and 84.8% respectively. The specificity was 83.9%, 85.1%, 100% and 100% respectively. The incidence of STaVF + V2 <0 in LCX group ①②was significantly higher than that in RCA group (x2 = 42.43,49.26, p <0.01), the sensitivity was 83.7% and 94.0% respectively, and the specificity was 100% . Conclusion STaVL ↓> STl ↓ ①, STIII ↑> STII ↑ ②, ① + ②, STaVF + Ⅴ2> 0 and ① ② do not have both, STaVF + V2 <0 in judging the infarct-related artery of acute inferior myocardial infarction is RCA or LCX and occlusion sites are highly specific and have important predictive value.