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題 名 | Prediction of Right Ventricular Infarction from Standard Surface ECG in Patients with Inferior Myocardial Infarction=以標準心電圖預測下壁心肌梗塞病人右心室梗塞之發生 |
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作 者 | 卜詩筠; 黃金隆; 陳政康; 何鴻鋆; 李文領; 黃達三; 陳穎從; 丁紀臺; | 書刊名 | 中華醫學雜誌 |
卷 期 | 61:5 1998.05[民87.05] |
頁 次 | 頁253-259 |
分類號 | 415.3023 |
關鍵詞 | 心電圖; 下壁心肌梗塞; 右心室梗塞; Electrocardiography; Inferior myocardial infarction; Right ventricular infarction; |
語 文 | 英文(English) |
中文摘要 | 背景右心室梗塞常為下壁心冗梗塞之合併症,由於其血流動力學的特殊變化,已 成為臨床醫師診治的重要課題。而右胸前導程心電圖,尤其右胸前第四導程(V4R)心電圖 現視為診斷右心室心肌梗塞重要的臨床工具。但仍需耗費較多時間。我們嘗試研究下壁心肌 梗塞心電圖的變化,觀察是否能從一般標準心電圖來判斷右心室梗塞。 方法本研究首先分析50個下壁心肌梗塞病人12導程心電圖的變化。並分析其與右心室梗塞之 相關性。以此為基礎發展出以12導程心電圖診斷右心室梗塞的新標準。再以新的標準去檢驗 另外一組48個下壁心肌梗塞病人,是否合併右心室梗室的發生,進而評估新標準的預測性。 結果根據分析第一組病人心電圖變化與右心室梗塞的關係,發現心電圖第一導程(lead I) 與左臂導程(lead aVL)ST節段(ST segment)的下降與右心室梗塞有很高的相關性。又以 lead I 與lead aVL ST節段下降相加大於0.2 mV(I+aVL≧0.2 mV)為最有預測價值。而將 此新標準用來測驗第二組的病人,且發現其對預測右心室梗塞有很高的準確性(敏感度 94.7%、特異度89.7%、陽性預測率85.7%、陰性預測率96.3%)。 結論對於下壁心肌梗塞的病人,以此新的心電圖診斷標準有助於在臨床上利用標準心電圖判 斷右心室梗塞。 |
英文摘要 | Background. Patients with inferior myocardial infarction (MI) have a 45% chance of having concurrent right ventricular infarction (RVI); of these, 5-10% suffer hemodynamic collapse. Immediate correct diagnosis and appropriate management of such patients is vital. ST-segment elevation in the right precordial V4 lead (V4R) has a high diagnostic value in identifying RVI, but this determination requires additional time and cost. An attempt was made to use a collection of patients' standard surface electrocardiograms (ECG) to find any available data to detect RVI and to lead to a new way to diagnose RVI. Methods. Fifty patients (Males/females, 44/6; mean age, 64.3��6.9 years) with acute inferior myocardial infarction were enrolled in a first group to develop new diagnostic criteria for RVI. As a first step, the ST-segment change in every standard surface ECG lead was analyzed and compared with corresponding changes in V4R. RVI was diagnosed by typical clinical symptoms (chest pain for more than 30 minutes, ST elevation > 0.1 mV and enzyme changes) accompanying ST elevation of more than 0.1 mV in V4R (by Lopez-Sendon criteria) and echocardiographic findings. RVI was diagnosed in 24 (48%) patients using ECG. The new criteria were then tested in a secondary group of 48 patients (males/females, 43/5; mean age, 65.5��7.9 years) with inferior MI. Results. Analysis of these patients found that ST depression in lead I and VL was a specific characteristic of RVI (I+aVL>0.2 mV). This criterion was applied to another group of patients with acute inferior MI to check the predictive value (sensitivity, 94.7%; specificity, 89.7%; positive predictive value, 85.7%; negative predictive value, 96.3%). Conclusions. In patients with evolving inferior MI, standard surface ECG analyzed for this criterion could aid clinical recognition of concomitant RVI. |
本系統中英文摘要資訊取自各篇刊載內容。