CAJ | 학술논문

目的：探讨心电图V4 R导联和aVR导联ST段改变对急性下壁ST段抬高型心肌梗死患者罪犯血管的判断价值。方法选取2001年1月—2013年6月于北京大学人民医院就诊的急性下壁ST段抬高型心肌梗死患者157例，行急诊冠状动脉造影证实罪犯血管，右冠状动脉（ RCA）近端组87例，RCA远端组35例，左回旋支（ LCX）组33例，余2例患者为左前降支闭塞，总结心电图V4 R和aVR导联ST段特点。结果3组收缩压比较，差异有统计学意义（F=4.919，P<0.05），其中RCA远端组和LCX组收缩压高于RCA近端组（P<0.05）。3组间V4R导联和aVR导联ST段变化的分布比较，差异均有统计学意义（χ2值分别为39.842、21.025，P<0.05）。V4 R导联ST段抬高预测RCA近端闭塞的灵敏度为41%（36/81），特异度为87%（59/68）；aVR导联ST段压低预测 LCX 闭塞的灵敏度为39%（13/33），特异度为93%（113/122）。结论急性下壁ST段抬高型心肌梗死时，V4 R导联ST段抬高更多见于RCA近端闭塞，aVR导联的ST段压低更多见于LCX闭塞，二者对判断罪犯血管特异度较高，但灵敏度较差。
목적：탐토심전도V4 R도련화aVR도련ST단개변대급성하벽ST단태고형심기경사환자죄범혈관적판단개치。방법선취2001년1월—2013년6월우북경대학인민의원취진적급성하벽ST단태고형심기경사환자157례，행급진관상동맥조영증실죄범혈관，우관상동맥（ RCA）근단조87례，RCA원단조35례，좌회선지（ LCX）조33례，여2례환자위좌전강지폐새，총결심전도V4 R화aVR도련ST단특점。결과3조수축압비교，차이유통계학의의（F=4.919，P<0.05），기중RCA원단조화LCX조수축압고우RCA근단조（P<0.05）。3조간V4R도련화aVR도련ST단변화적분포비교，차이균유통계학의의（χ2치분별위39.842、21.025，P<0.05）。V4 R도련ST단태고예측RCA근단폐새적령민도위41%（36/81），특이도위87%（59/68）；aVR도련ST단압저예측 LCX 폐새적령민도위39%（13/33），특이도위93%（113/122）。결론급성하벽ST단태고형심기경사시，V4 R도련ST단태고경다견우RCA근단폐새，aVR도련적ST단압저경다견우LCX폐새，이자대판단죄범혈관특이도교고，단령민도교차。
Objective To evaluate the value of ST deviations in V4 R and aVR lead for culprit artery location among patients with acute inferior wall ST-elevation myocardial infarction(STEMI). Methods 157 patients with acute inferior wall STEMI who came to the Peking University People's Hospital from January 2001 to June 2013,were selected as study subjects. The culprit artery was confirmed by emergent coronary angiography. The location of culprit artery:proximal right coronary artery for 87 cases( group proximal RCA),distal right coronary artery for 35 cases( group distal RCA),left circumflex artery for 33 cases ( group LCX),and left anterior descending artery for the other 2 cases. The characteristics of ST in V4 R and aVR lead ECG were summarized. Results There was significant difference in systolic blood pressure( SBP)among three groups( F=4. 919,P<0. 05),SBP in group distal RCA and group LCX was significantly higher than that in group proximal RCA respectively( P <0. 05). There were significant differences in distribution of ST changes in V4R and aVR lead among three groups(χ2 was 39. 842 and 21. 025 respectively,both P <0. 05). The predictive sensitivity and specificity of ST elevation in V4R lead for proximal RCA occlusion was 41%(36/81)and 87%(59/68)respectively. And the predictive sensitivity and specificity of ST depression in aVR lead for LCX occlusion was 39%( 13/33 ) and 93%( 113/122 ) respectively. Conclusion For acute inferior wall STEMI,ST elevation in V4 R lead most often occurs in proximal RCA occlusion,ST depression in aVR lead most often occurs in LCX occlusion,the sensitivity of ST deviations in judging culprit artery location was relatively low and the spectificity was rela-tively high.