De Hert S G, De Jongh R F, Van den Bossche A O, De Maere P L, Adriaensen H F
Department of Anaesthesia, University Hospital Antwerp, Edegem, Belgium.
Anaesthesia. 1989 Nov;44(11):881-4. doi: 10.1111/j.1365-2044.1989.tb09139.x.
The value of monitoring the right precordial lead, V4R, to detect peri-operative ischaemic events during coronary artery surgery was studied in 60 patients. Thirty-four patients had only left-sided coronary disease (Group 1). The other 26 patients had both left-sided occlusive coronary artery disease and significant right-sided occlusive lesions on coronary angiography (Group 2). Lead sensitivity was estimated, assuming that all ST segment changes were true positive responses. Sensitivity using a single lead was greatest for lead V5 in the two groups (73% for Group 1 and 69% for Group 2). Sensitivity in Group 1 for lead II was intermediate (55%), whereas sensitivity for lead V4R was only 9%. In Group 2, on the other hand, lead V4R was 54% sensitive and lead II only 31%. The combination of leads V4R and V5 increased the sensitivity to 92% in Group 2, whereas lead II or V5 combined with V4R failed to improve sensitivity in Group 1. The monitoring of lead V4R allowed detection of 23% of the ischaemic episodes in Group 2 that would have passed undetected if only lead II and V5 were monitored. These results demonstrate the value of an additional right precordial lead during coronary artery bypass grafting in patients with right-sided occlusive disease.
对60例患者研究了监测右胸前导联V4R以检测冠状动脉手术围手术期缺血事件的价值。34例患者仅患有左侧冠状动脉疾病（第1组）。另外26例患者在冠状动脉造影时既有左侧闭塞性冠状动脉疾病又有明显的右侧闭塞性病变（第2组）。假设所有ST段改变均为真阳性反应，对导联敏感性进行了评估。两组中使用单导联时，导联V5的敏感性最高（第1组为73%，第2组为69%）。第1组中导联II的敏感性中等（55%），而导联V4R的敏感性仅为9%。另一方面，在第2组中，导联V4R的敏感性为54%，导联II仅为31%。导联V4R和V5联合使用使第2组的敏感性提高到92%，而导联II或V5与V4R联合使用未能提高第1组的敏感性。监测导联V4R可检测出第2组中23%的缺血发作，若仅监测导联II和V5则这些发作会未被发现。这些结果证明了在患有右侧闭塞性疾病的患者进行冠状动脉搭桥手术期间增加右胸前导联的价值。
