中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2014年
10期
21-24
,共4页
心肌梗塞%冠状血管%四步法
心肌梗塞%冠狀血管%四步法
심기경새%관상혈관%사보법
Myocardial infarction%Coronary vessels%Four-step method
目的 探讨四步法对急性下壁心肌梗死罪犯血管(右冠状动脉近端、远端,左回旋支)的判定价值.方法 87例急性下壁心肌梗死患者,根据发病24h内心电图各导联ST段特征,按照四步法流程进行判定.统计分析各步的诊断正确率及各步的诊断灵敏度、特异度、阳性预测值、阴性预测值.结果 诊断流程第一步正确诊断率分别为2/2和27/28(96.4％),灵敏度均较低,特异度均较高.第二步正确诊断率分别为12/18和36/39 (92.3％).第三步正确诊断率分别为2/4和34/35(97.1％).第一步至第三步正确诊断率分别为16/24(66.7％)和61/63(96.8％),灵敏度较高,特异度亦较高.第四步正确诊断率分别为29/38(76.3％)和16/25(64.0％),对右冠状动脉近端病变的灵敏度高于对右冠状动脉远端病变的灵敏度(78.4％比66.7％).结论 急性下壁心肌梗死患者应用四步法判定罪犯血管的诊断正确率、特异度、阳性预测值均较高,有重要的临床应用价值.
目的 探討四步法對急性下壁心肌梗死罪犯血管(右冠狀動脈近耑、遠耑,左迴鏇支)的判定價值.方法 87例急性下壁心肌梗死患者,根據髮病24h內心電圖各導聯ST段特徵,按照四步法流程進行判定.統計分析各步的診斷正確率及各步的診斷靈敏度、特異度、暘性預測值、陰性預測值.結果 診斷流程第一步正確診斷率分彆為2/2和27/28(96.4％),靈敏度均較低,特異度均較高.第二步正確診斷率分彆為12/18和36/39 (92.3％).第三步正確診斷率分彆為2/4和34/35(97.1％).第一步至第三步正確診斷率分彆為16/24(66.7％)和61/63(96.8％),靈敏度較高,特異度亦較高.第四步正確診斷率分彆為29/38(76.3％)和16/25(64.0％),對右冠狀動脈近耑病變的靈敏度高于對右冠狀動脈遠耑病變的靈敏度(78.4％比66.7％).結論 急性下壁心肌梗死患者應用四步法判定罪犯血管的診斷正確率、特異度、暘性預測值均較高,有重要的臨床應用價值.
목적 탐토사보법대급성하벽심기경사죄범혈관(우관상동맥근단、원단,좌회선지)적판정개치.방법 87례급성하벽심기경사환자,근거발병24h내심전도각도련ST단특정,안조사보법류정진행판정.통계분석각보적진단정학솔급각보적진단령민도、특이도、양성예측치、음성예측치.결과 진단류정제일보정학진단솔분별위2/2화27/28(96.4％),령민도균교저,특이도균교고.제이보정학진단솔분별위12/18화36/39 (92.3％).제삼보정학진단솔분별위2/4화34/35(97.1％).제일보지제삼보정학진단솔분별위16/24(66.7％)화61/63(96.8％),령민도교고,특이도역교고.제사보정학진단솔분별위29/38(76.3％)화16/25(64.0％),대우관상동맥근단병변적령민도고우대우관상동맥원단병변적령민도(78.4％비66.7％).결론 급성하벽심기경사환자응용사보법판정죄범혈관적진단정학솔、특이도、양성예측치균교고,유중요적림상응용개치.
Objective To study the significance of four-step method for the determination of the infarct-related artery (proximal and distal right coronary artery;left circumflex artery) in patients with acute inferior myocardial infarction (AIMI).Methods A 12-lead surface electrocardiogram was obtained in 87 patients who had AIMI in 24 h.On the basis of the characteristics of ST-segment,indices such as diagnostic accuracy,sensitivity,specificity,positive and negative predictive values were evaluated to determine the ability of the four-step method to identify the culprit vessels.Results The accuracy of the first diagnostic step was 2/2 and 27/28 (96.4％),with lower sensitivity and higher specificity; the accuracy of the second diagnostic step was 12/18 and 36/39(92.3％); and the third was 2/4 and 34/35 (97.1％).From the first to the third step,the accuracy was 16/24 (66.7％) and 61/63 (96.8％),with higher sensitivity and specificity.The accuracy of the fourth diagnostic step was 29/38 (76.3％) and 16/25 (64.0％),and the sensitivity for proximal right coronary artery lesion was higher than that in distal right coronary artery lesion [78.4％ vs.66.7％].Conclusions The diagnostic accuracy,specificity and positive predictive values of four-step method in the determination of culprit artery are all very high,so the four-step method has important clinical significance in predicting culprit artery in AIMI.
