CAJ | 학술논문

目的:探讨梗死性室性异位心搏（IVEB）的临床、心电图特点及其在急性心肌梗死（AMI）早期诊断和定位中的价值。方法:对17例在AMI时出现IVEB的患者与同期住院的57例无IVEB的AMI患者进行对照分析，并比较IVEB与同期窦性心律和充分进展期窦性心律的QRS-ST-T波群的形态学改变。结果:① IVEB的QRS形态常呈右束支阻滞形态；除Q波型AMI外，非Q波型AMI 亦可发生IVEB。②单因素分析显示IVEB常发生于AMI的早期（＜4h），以下壁伴或不伴后壁及(或)右室AMI好发（P<0.05～0.001);多因素非条件logistic回归分析显示下（后）壁AMI、大面积MI、心功能差及梗死早期（＜4h）者易发生IVEB(χ2=3.87～12.05,P<0.05)。③ 与同期窦性心律比较，IVEB Q波出现及ST段抬高提早，且更具有AMI的特征。④IVEB可发生于心肌酶学升高及窦性心律典型AMI图型出现之前，其对AMI的早期诊断及定位，优于同期窦性心律。结论:IVEB并非罕见，它有助于AMI的早期诊断及定位。
목적:탐토경사성실성이위심박（IVEB）적림 상、심전도특점급기재급성심기경사（AMI）조기진단화정위중적개치。방법:대17례재AMI시출현IVEB적환자여동기주원적57례무IVEB적AMI환자진 행대조분석，병비교IVEB여동기두성심률화충분진전기두성심률적QRS-ST-T파군적형태학 개변。결과:① IVEB적QRS형태상정우속지조체형태；제Q파형AMI외，비Q파형AMI 역가발생IVEB。②단인소분석현시IVEB상발생우AMI적조기（＜4h），이하벽반혹불반후벽 급(혹)우실AMI호발（P<0.05～0.001);다인소비조건logistic회귀분석 현시하（후）벽AMI、 대면적MI、심공능차급경사조기（＜4h）자역발생IVEB(χ2=3.87～12.05,P<0.05)。③ 여동기두성심률비교，IVEB Q파출현급ST단태고제조，차경구유AMI적특정。④IVEB가발생 우심기매학승고급두성심률전형AMI도형출현지전，기대AMI적조기진단급정위，우우동기두 성심률。결론:IVEB병비한견，타유조우AMI적조기진단급정위。
Objective： To investigate the clinical and electrocardiograph character of infarctional ven tricular ectopic beat (IVEB) and its value in early diagnosis and location fo r acute myocardial infarction(AMI). Methods： 17 AMI patients with IVEB and 57 AMI patients without IVEB were analyzed.A comparison was made between IVEB and sinus rhythm of the same pe riod and fully developed phase in morphlogical changes of QRS complex 、ST s egment and T wave.Results： ① IVEB QRS complex often revealed the right bundle branch block morphology (RB BBM), beside Q-waves AMI, no-Q-waves AMI had IVEB.②Single-factor analysis f ou nd IVEB often appeared in early AMI(＜4h).They were more frequent in inferopos te rior with/without right ventricular　involvement than those anterior or ant eroseptal myocarction .Multi-factors no condition logistic regress analysis rev e aled IVEB had positive correlation with the early AMI、AMI size、killi p h eart function degree、inferoposterior with/without right ventricular involvem ent(X2=3.87～12.05,p<0.05).③The Q wave of IVEB was winder and ST seg ment elevation was higher than that of the same period sinus rhythm.④The infar ctional morphological changes of venteicular ectopic beats could be found bef ore same period sinus rhythm and myocardial enzyme rise. Conclusion： IVEB is not rare.They are always useful in the early diagnosis and locatio n of AMI.