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目的:分析急性ST段抬高型心肌梗死(STEMI)患者梗死相关动脉(IRA)为第一对角支的心电图特点,试图发现其规律为临床医师提供准确快捷的诊断依据。方法:回顾性分析2005-01至2014-06上海市第一人民医院STEMI患者IRA为第一对角支(均经冠状动脉造影证实)的心电图资料28例,分析患者入院时心电图各导联ST段抬高、压低的情况及演变期q波或Q波的变化。结果:28例患者冠状动脉造影结果显示单支病变19例(67.9%),孤立性对角支病变为13(46.4%)。28例患者从发病至心电图出现急性心肌梗死图形的时间大约为240(252±71)min。28例患者均有aVL导联ST段抬高;27例(96.4%)有I导联ST段抬高,其中15例(55.6%)患者ST段抬高介于0.5~1.0 mm;胸前导联ST段抬高的导联依次为:V2导联21例(75.0%)、V3导联16例(57.1%)、V1导联12例(42.9%)。ST段压低最明显的Ⅲ导联28例(100%),其次为a VF导联27例(96.4%)、Ⅱ导联22例(78.6%)。演变期q波或Q波形成最多的是a VL导联22例(88.0%),其次为V2导联10例(40.0%)、V3导联9例(36.0%),Ⅰ导联7例(28.0%)。结论:IRA为第一对角支的心电图图形表现为a VL和Ⅰ导联ST段抬高,但ST段抬高幅度近一半不到1.0 mm是其重要特点。
OBJECTIVE: To analyze the electrocardiographic features of the first diagonal branch of infarct-related artery (IRA) in patients with acute ST-elevation myocardial infarction (STEMI) and to find out its regularity to provide clinicians with accurate and rapid diagnostic evidence. Methods: A retrospective analysis of 28 patients with IRA of the first diagonal branch of STEMI in Shanghai First People ’s Hospital from January 2005 to June 2014 confirmed by coronary angiography was performed. The electrocardiogram ST Segment elevation, depression and the evolution of q-wave or Q-wave changes. Results: The results of coronary angiography in 28 patients showed that there were 19 cases (67.9%) with single vessel disease and 13 (46.4%) with isolated diagonal vessel disease. The time to onset of acute myocardial infarction patterns in 28 patients from onset to electrocardiogram was approximately 240 (252 ± 71) min. ST segment elevation was observed in aVL lead in 28 patients. ST segment elevation in I lead was found in 27 patients (96.4%), and ST segment elevation in 0.5% to 1.0 mm was found in 15 patients (55.6%). There were 21 cases (75.0%) of V2 leads, 16 cases (57.1%) of V3 leads, and 12 cases (42.9%) of V1 lead. Among the 28 patients (100%) with the most obvious ST-segment depression, 27 were lead a (96.4%) and 22 were lead II (78.6%). In the evolutionary phase, the largest number of q wave or Q wave was a VL lead in 22 cases (88.0%) followed by V2 lead in 10 cases (40.0%), V3 lead in 9 cases (36.0%) and lead I in 7 cases 28.0%). CONCLUSIONS: The IRA is the first diagonal branch of the ECG showed a VL and Ⅰ lead ST segment elevation, but the ST segment elevation of less than 1.0 mm is less than 1.0 mm is an important feature.