CAJ | 학술논문

目的：分析不同罪犯血管引起的急性下壁心肌梗死患者的临床特点。方法纳入发病12 h内入院的急性下壁心肌梗死患者268例，急诊行冠状动脉造影（CAG）检查，根据不同罪犯血管将患者分为2组，右冠状动脉（RCA）组：216例为闭RCA塞；左回旋支冠状动脉（LCX）组：52例为LCX闭塞。对两组临床特征和心电图进行比较分析。结果合并右室心肌梗死，心源性休克，RCA组心力衰竭显著高于LCX组（P＜0.05）；RCA组左室射血分数（LVEF）显著低于LCX组[（51±8）％vs.（58±10）％， P＜0.05]；但住院死亡率等两组比较差异无统计学意义（P＞0.05）；心电图STⅢ抬高/STⅡ抬高≥1、STV4R抬高≥1 mm、高度房室传导阻滞（AVB）、室速/室颤（VT/VF）各项指标在RCA组显著高于LCX组（P＜0.01）。结论 RCA和LCX梗死引起的急性下壁心肌梗死临床特征和心电图表现有差异，心电图Ⅱ、Ⅲ及V4R导联ST段变化能预测急性下壁心肌梗死患者犯罪血管，对临床治疗和预后有指导作用。
목적：분석불동죄범혈관인기적급성하벽심기경사환자적림상특점。방법납입발병12 h내입원적급성하벽심기경사환자268례，급진행관상동맥조영（CAG）검사，근거불동죄범혈관장환자분위2조，우관상동맥（RCA）조：216례위폐RCA새；좌회선지관상동맥（LCX）조：52례위LCX폐새。대량조림상특정화심전도진행비교분석。결과합병우실심기경사，심원성휴극，RCA조심력쇠갈현저고우LCX조（P＜0.05）；RCA조좌실사혈분수（LVEF）현저저우LCX조[（51±8）％vs.（58±10）％， P＜0.05]；단주원사망솔등량조비교차이무통계학의의（P＞0.05）；심전도STⅢ태고/STⅡ태고≥1、STV4R태고≥1 mm、고도방실전도조체（AVB）、실속/실전（VT/VF）각항지표재RCA조현저고우LCX조（P＜0.01）。결론 RCA화LCX경사인기적급성하벽심기경사림상특정화심전도표현유차이，심전도Ⅱ、Ⅲ급V4R도련ST단변화능예측급성하벽심기경사환자범죄혈관，대림상치료화예후유지도작용。
Objective To analyze the clinical characteristics of inferior acute myocardial infarction (AMI) induced by different culprit vessels. Methods The patients (n=268) with inferior AMI attacked within 12 h were chosen and given emergency coronary angiography (CAG), and divided, according to different culprit vessels, into RCA group (with RCA occlusion, n=216) and LCX group (with LCX occlusion, n=52). The clinical characteristics and electrocardiogram (ECG) indexes were compared between 2 groups. Results The patients with right ventricular myocardial infarction, cardiac shock and heart failure were significantly more in RCA group than those in LCX group (P<0.05). LVEF was significantly lower in RCA group than that in LCX group (51±8%vs. 58±10%, P<0.05). The difference in in-hospital mortality had no statistical significance between 2 groups (P>0.05). The indexes of STⅢelevation/STⅡelevation≥1, STV4R elevation≥1 mm, AVB and VT/VF were all significantly higher in RCA group than those in LCX group (P<0.01). Conclusion Inferior AMI induced by RCA occlusion or LCX occlusion has different clinical characteristics and ECG expressions. The ST-segment changes of ECGⅡlead,Ⅲlead and V4R lead can predict culprit vessels in patients with inferior AMI, which has guide effect on clinical treatment and prognosis.