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目的:从心电图aVR导联判断急性前壁、下壁心肌梗死患者梗死相关血管(IRA)的意义。方法:选择本院2006年1月-2008年11月,首次因急性前壁心肌梗死89例和急性下壁心肌梗死75例,对比两者心电图aVR导联、冠脉造影、超声心动图结果的改变。结果:IRA为左主干(LM)8例、左前降支(LAD)81例、左回旋支(LCX)17例和右冠状动脉(RCA)58例。以aVR导联ST段压低≥1 mm为诊断标准,诊断LCX为IRA的敏感度为76.5%,特异度为94.8%,阳性预测值为81.3%,阴性预测值93.2%;而对RCA诊断的敏感度、特异度均低。aVR导联ST段抬高≥0.5 mm,其预测IRA为LM的敏感度为75%、特异度74.1%、阳性预测值22.2%、阴性预测值96.7%。对LM+LAD近段预测的敏感度为51.1%、特异度92.8%、阳性预测值88.9%、阴性预测值62.9%。结论:急性前壁、下壁心肌梗死患者心电图aVR导联ST段改变用于判断患者的IRA和预后有一定的临床意义。
OBJECTIVE: To determine the significance of IRA in acute anterior wall and inferior wall myocardial infarction from aVR lead of ECG. Methods: The hospital from January 2006 to November 2008, for the first time in 89 cases of acute anterior myocardial infarction and acute inferior myocardial infarction in 75 cases, comparing the two ECG aVR lead, coronary angiography, echocardiography results change. Results: IRA included 8 cases of left main trunk (LM), 81 cases of left anterior descending artery (LAD), 17 cases of left circumflex artery (LCX) and 58 cases of right coronary artery (RCA). The sensitivity of LCX to IRA was 76.5%, the specificity was 94.8%, the positive predictive value was 81.3% and the negative predictive value was 93.2% based on the aVR ST-segment depression ≥1 mm, while the sensitivity to RCA diagnosis Degree and specificity are low. The aVR lead ST segment elevation ≥0.5 mm, its prediction IRA LM sensitivity of 75%, specificity of 74.1%, positive predictive value of 22.2%, negative predictive value of 96.7%. The sensitivity of LM + LAD prediction was 51.1%, the specificity was 92.8%, the positive predictive value was 88.9% and the negative predictive value was 62.9%. Conclusion: The changes of ST segment of aVR lead in patients with acute anterior and inferior myocardial infarction have some clinical significance in judging IRA and prognosis of patients.