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目的探讨急性前壁心肌梗死患者aVR导联ST段变化的临床意义。方法首次急性前壁心肌梗死患者75例,均经再灌注治疗及冠状动脉造影,依据心电图aVR导联ST段变化将病例分为抬高组、无偏移组和下移组。结果前降支再灌注TIMI分级0~1级在ST段抬高组、无偏移组、下移组分别为15例(78.9%)、31例(91.2%)、21例(95.5%),后两组与ST段抬高组比较有显著差异(P<0.05)。相对2~3级血流也类似情况,ST段抬高组与后两组比较有显著差异(P<0.01),犯罪血管为左主干病变的ST段抬高组、无偏移组、下移组分别为4例(21.1%)、1例(2.9%)、3例(13.6%),有显著差异(P<0.01);病变范围为前降支近端至S1,病变范围为前降支近端至D1,三组无明显差异,多支病变和侧支循环形成2级以上ST段抬高组与无偏移组,下移组与无偏移组均有显著差异(P<0.05);早期临床情况显示ST段抬高组和ST段下移组的血清BNP和cTnI明显高ST段无偏移组(P<0.05);ST段抬高组和下移组行CABG和IABP应用明显高于无偏移组(P<0.01),而左室射血分数(LVEF)无明显差异(P>0.05)。结论急性前壁心肌梗死患者如果aVR导联ST段抬高或下移可能提示有严重的左主干病变,左前降支病变或严重的多支病变,且有大面积的心肌梗死,心肌收缩功能损害明显,应用IABP或急诊CABG比率增高
Objective To investigate the clinical significance of ST segment changes in aVR lead in patients with acute anterior myocardial infarction. Methods The first 75 patients with acute anterior myocardial infarction were treated by reperfusion and coronary angiography. The cases were divided into elevation group, non-migration group and down-migration group according to the changes of ST segment in aVR lead of electrocardiogram. Results In the ST segment elevation group, there were 15 cases (78.9%), 31 cases (91.2%), 21 cases (95.5%) in the ST segment elevation group, There was a significant difference between the latter two groups and the ST elevation group (P <0.05). Relative to Grade 2 to Grade 3 blood flow, there was a significant difference between the ST segment elevation group and the latter two groups (P <0.01). The culprit blood vessels were ST segment elevation in the left main trunk disease without offsetting group and down (21.1%), 1 case (2.9%) and 3 cases (13.6%), respectively. There were significant differences between the two groups (P <0.01) There was no significant difference between the three groups in proximal end to D1. The multi-vessel disease and collateral circulation formed more than grade 2 ST-segment elevation group and no-offset group, with significant difference (P <0.05) ; Early clinical manifestations showed that ST-segment elevation group and ST-segment down-group serum BNP and cTnI significantly higher ST-segment non-skewed group (P <0.05); ST-segment elevation group and down the line of CABG and IABP significantly (P <0.01), while there was no significant difference in left ventricular ejection fraction (LVEF) (P> 0.05). Conclusions ST elevation or down-shift of aVR leads may indicate serious left main trunk lesion, left anterior descending coronary artery disease or severe multi-vessel lesion in patients with acute anterior myocardial infarction, with large myocardial infarction and myocardial contractile function impairment Obviously, the rate of IABP or emergency CABG increases