摘要
目的:分析急性心肌梗死患者梗死相关动脉(IRA)与心电图ST段不同特征改变的相关性。方法:选取在医院心血管内科进行治疗的317例急性心肌梗死患者,其中急性下壁心肌梗死患者138例,急性前壁心肌梗死患者179例(单支病变146例,多支病变33例)。患者于入院10 min及入院后第1 d每隔4~8 h,第2 d每隔12~24 h测定患者18导联心电图,将确定的冠状动脉病变部位分别记为左前降支(LAD)、左回旋支(LCX)和右冠状动脉(RCA)。采用受试者工作特征(ROC)曲线下面积(AUC)分析急性下壁、前壁心肌梗死患者心电图特征与RCA及LCX的关系,分析急性前壁心肌梗死患者心电图检查时Ⅲ导联ST段上升幅度大于Ⅱ导联ST段上升幅度(STⅢ>Ⅱ抬高)、aVL导联ST段下移幅度>1 mV(ST_(aVL)下移>1 mV)、V3导联ST段下移幅度/Ⅲ导联ST段上升幅度≤1.2(STV3下移/STⅢ抬高≤1.2 mV)、Ⅰ导联ST段下移幅度≥0.05 mV(STⅠ下移≥0.05 mV)、V4R导联ST段上升幅度≥1 mV(STV4R抬高≥1 mV)和V6导联ST段下移幅度≥0.05 mV(STV6下移≥0.05 mV)5个特征与LAD的关系,以及病变冠状动脉支数与胸前导联ST段下降的关系。结果:ST段特征中ST_(aVL)下移>1的阳性预测值及特异度高于STⅠ下移≥0.05 mV特征,其差异有统计学意义(x^(2)=14.839,x^(2)=12.804;P<0.05);STⅢ>Ⅱ抬高的阴性预测值及灵敏度高于STV6下移≥0.05 mV特征,其差异均有统计学意义(x^(2)=20.833,x^(2)=44.426;P<0.05)。预测RCA中ST_(aVL)下移>1特征的阳性预测值、阴性预测值及灵敏度和特异度最高,且AUC优于STⅢ>Ⅱ抬高、ST_(V3)下移/STⅢ抬高≤1.2 mV、ST_(Ⅰ)下移≥0.05 mV、STV4R抬高≥1 mV和ST_(V6)下移≥0.05 mV特征,差异均有统计学意义(Z=2.369,Z=3.498,Z=15.639,Z=16.385,Z=18.251;P<0.05)。预测LCX中,ST段下移≥0.1 mV的阳性预测值、阴性预测值、灵敏度及特异度均明显高于ST段抬高>0.1 mV;ST_(aVL)抬高≤STⅠ抬高的AUC优于ST_(Ⅲ)抬高≤ST_(Ⅱ)抬高、STV3
Objective:To analyze the correlation between infarct related artery(IRA)and the changes of different characteristics of ST segment of electrocardiogram(ECG)in patients with acute myocardial infarction.Methods:317 patients with acute myocardial infarction who were treated in cardiovascular department of hospital were selected,which included 138 patients with acute inferior wall myocardial infarction and 179 patients with acute anterior myocardial infarction(including 146 cases of single vessel disease and 33 cases of multi vessel disease).The 18 lead ECG was used to measure patients within 10 minutes after admission,every 4-8 hours on the first day and every 12-24 hours on the second day.The determined locations of coronary artery lesions were recorded as left anterior descending branch(LAD),left circumflex artery(LCX)and right coronary artery(RCA).The area under curve(AUC)of receiver operating characteristic(ROC)curve was used to analyze the relationships between ECG characteristics and RCA and LCX in patients with acute inferior wall and anterior myocardial infarction,and to analyze the relationship between 5 characteristics[the rising amplitude of ST segment in lead III was greater than that in lead II(ST_(Ⅲ)>II_(elevation)),the amplitude of downward displacement of ST segment in lead aVL was greater than 1 mV(ST_(aVL) downward shift>1 mV),the ratio of downward displacement of ST segment in lead V3 to the rising amplitude of ST segment in lead III was less than or equal to 1.2(STV3 downward shift/ST_(Ⅲelevation shift)≤1.2mV),the downward displacement of ST segment in lead I was greater than or equal to 0.05 mV(ST_(Ⅰdownward shift)≥0.05 mV),the rising amplitude of ST segment in lead V4R was greater than or equal to 1 mV(ST_(v4R elevation)≥1 mV)and the amplitude of downward of ST segment in lead V6 was greater than or equal to 0.05 mV(STV6 downward shift≥0.05 mV)]and LAD of patients with acute anterior myocardial infarction during ECG examination,and to analyze the relationship between the number of
作者
雷婷婷
张倩
李成辉
LEI Ting-ting;ZHANG Qian;LI Cheng-hui(Department of Function,No.215 Hospital of Shaanxi Nuclear Industry,Xianyang,China)
出处
《中国医学装备》
2021年第11期100-104,共5页
China Medical Equipment
基金
陕西省2018年度卫生健康科研项目(2018E015)“急性心肌梗死患者冠脉内血栓类型与心电图ST段改变的相关性研究”。
关键词
急性心肌梗死
梗死相关动脉(IRA)
心电图(ECG)ST段
价值评估
冠状动脉造影
Acute myocardial infarction
Infarct related artery(IRA)of infarct related artery
Electrocardiogram(ECG)ST segment
Value assessment
Coronary angiography
