18导联心电图st段抬高对急性心肌梗死的临床价值.doc

18导联心电图ST段抬高对急性心肌梗死的临床价值 【摘要】目的 探讨18导联心电图中ST段抬高对急性心肌梗死的临床诊断价值。方法 对332例急性心肌梗死患者，在原有标准12导联的基础上，增加后壁（V7，V8, V9）和右胸导联(V3R,V4R,V5R),观察附加导联ST段抬高，是否可以提高心电图诊断急性心肌梗死的价值。结果12导联心电图诊断急性心肌梗死的敏感性为71.4%，特异性为86.0%；12导联+后壁导联诊断急性心肌梗死敏感性为79.2%，特异性为85.0%；12导联+右胸导联诊断急性心肌梗死敏感性为81.9%，特异性为83.7%。结论 增加后壁和右胸导联可提高诊断急性心肌梗死敏感性，而特异性无显著降低。 【关键词】急性心肌梗死；18导联；ST段抬高 Clinical value of the ST segment change in 18-lead ECG for diagnosing acute myocardial infarction limingjun hanyang wulei Xian Medical College Hospital function Branch,710077,China. 【Abstract】Objective To investigate the clinical value of 18-lead ECG in diadnosing acute myocardial infarction .Method 18-lead ECG,in which added posterior precordial leads V7, V8, V9 and right posterior precordial leads V3R, V4R, V5R to standard 12 leads ,was recorded in 332 patients with acute myocardial infarction.For detection of acute myocardial infarction, the value of ST segment change in segment change in additional posterior and right precordial leads comparison with standard 12leads was observed .The hypothesis that the additional leads could improve the diagnosistic value of ECG　ｉｎ　acute myocardial infarction　was assessed . Results The sensitivity and specificity for diagnosis acute myocardial infarction,in 12 leads was 71.4% and 86.0%,in 12 leads+ posterior leads was 79.2% and 81.9 %, in 12 leads+ right precordial leads was 75.3% and 84.5 %,and in 18-lead ECG was 81.9% and 83.7 %,respectively . Conclusion the additional posterior and right precordial leads increased the sensitivity but did not decrease specificity of ECG for the detection of acute myocardial infarction. 【key words】acute myocardial infarction; 18-lead ECG; ST segment change 急性心肌梗死多数是在冠脉粥样硬化的基础上由于不稳定板块破裂而致血栓形成，继而引起相应部位的心肌缺血 ，以致坏死。目前临床诊断的最快捷、简便、经济而且无创的方法P0.01为差异有显著性, P0.05为差异无显著性。 计算公式：敏感性=真阳性/（真阳性+假阴性）））