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目的：探讨前壁急性心肌梗死病人Ｖ１和Ｖ３Ｒ导联ＳＴ段变化与冠状动脉分布的关系。方法：前壁急性心肌梗死病人３４例，入院时均采集标准１２导联及Ｖ３Ｒ导联心电图，入院１０天内进行冠状动脉造影，评价心电图变化与冠状动脉分布的关系。根据Ｖ１导联ＳＴ段抬高幅度将病人分为两组：Ａ组（ＳＴ段抬高≥１．５ｍｍ，１５例）和Ｂ组（ＳＴ段抬高＜１．５ｍｍ，１９例）。将起源于右冠状动脉的圆锥动脉分为两种类型：小圆锥支型和大圆锥支型。结果：Ｖ３Ｒ导联ＳＴ段抬高在Ａ组和Ｂ组分别为１４例（９３％）和６例（３２％，Ｐ＜０．００１），小圆锥支型者在Ａ组和Ｂ组分别为１２例（８０％）和３例（１５％，Ｐ＜０．００１），大圆锥支型者１３例，均来自Ｂ组。结论：前壁急性心肌梗死病人入院时Ｖ１导联ＳＴ段抬高与Ｖ３Ｒ导联ＳＴ段抬高密切相关，均为小圆锥支型者。前壁急性心肌梗死Ｖ１导联无ＳＴ段抬高，表明除左前降支的间隔支供血外，心室间隔还得到大圆锥支型的血液供应而受到保护。
Objective: To investigate the relationship between ST segment changes in lead V1 and V3R and coronary artery distribution in patients with acute myocardial infarction on the anterior wall. Methods: Thirty-four patients with acute myocardial infarction in the anterior wall were enrolled in the standard 12-lead and V3R lead electrocardiogram at admission. Coronary angiography was performed within 10 days after admission to evaluate the relationship between ECG changes and coronary artery distribution. The patients were divided into two groups according to the amplitude of ST elevation in lead V1: group A (ST segment elevation≥1.5 mm, 15 cases) and group B (ST segment elevation <1.5 mm, 19 cases). The origin of the right coronary artery in the conical artery is divided into two types: small conical branch and large cone branch. Results: The ST segment elevation in V3R lead was 14 (93%) and 6 (32%, P <0.001) in group A and group B, respectively. The group of small cones in groups A and B were 12 cases (80%) and 3 cases (15%, P <0.001), and 13 cases with large conical branches, all from group B. CONCLUSION: The ST segment elevation in V1 lead and the ST segment elevation in V3R lead are closely related to the anterior wall acute myocardial infarction patients. All of them are small cones. There was no ST-segment elevation in the lead V1 of the anterior wall acute myocardial infarction, indicating that the ventricular septum was protected by the conical branch of the blood supply in addition to the septal branch of the left anterior descending artery.