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[急性心肌梗死血流动力学特征与心电图定位的关系]

[Hemodynamic profile of acute myocardial infarction as a function of electrocardiographic localization].

作者信息

Saadjian A, Ziza B, Arnould J L, Torresani J, Jouve A

出版信息

Arch Mal Coeur Vaiss. 1977 Jun;70(6):581-91.

PMID:407872
Abstract

The haemodynamic profiles of 147 cases of myocardial infarction investigated within 30 hours of the clinical onset were studies in relation to the topography of the necrosis on the ECG: there were 36 inferior (I), 29 postero-inferior (PI), 22 antero-septal (AS), 38 antero-lateral (AL), 15 deep septal (DS), and 7 strictly posterior or lateral (PL). Simultaneous recordings of the diastolic pulmonary arterial pressures and the left ventricular diastolic pressures (pre-and post-a) have shown different degrees of correlation with the topographical site. The correlation found in AS, AL and I necrosis are clearer with respect to the pre-a. The PI necroses show no correlation. Graphs of left ventricular function as well as an analysis of the various other parameters show that the DS, the AL, and to a lesser extent the PI are associated with the grossest depression of left ventricular function. A study of the amplitude of the "a" wave also shows that the effect of infacts of the free wall of the left ventricule on the compliance is greater. A study of right ventricular function as well as the correlations between the pulmonary and right atrial pressures confirms the presence of right ventricular disfunction in DS and PI necroses. Impaired left ventricular function, impaired right ventricular function, and disorders of compliance seem to be the determining factors in changing the haemodynamics in the various ECG sites of infarction.

摘要

对147例临床发病30小时内接受调查的心肌梗死患者的血流动力学特征进行了研究,研究内容与心电图上坏死区域的位置有关:下壁梗死(I)36例,后下壁梗死(PI)29例,前间隔梗死(AS)22例,前侧壁梗死(AL)38例,深间隔梗死(DS)15例,以及严格意义上的后壁或侧壁梗死(PL)7例。同时记录的舒张期肺动脉压和左心室舒张压(a波前后)与梗死部位显示出不同程度的相关性。在AS、AL和I梗死中,a波前的相关性更明显。PI梗死则无相关性。左心室功能图以及对其他各种参数的分析表明,DS、AL以及程度稍轻的PI与左心室功能的最严重抑制有关。对“a”波幅度的研究还表明,左心室游离壁梗死对顺应性的影响更大。对右心室功能以及肺动脉压与右心房压之间相关性的研究证实,DS和PI梗死中存在右心室功能障碍。左心室功能受损、右心室功能受损以及顺应性障碍似乎是改变梗死不同心电图部位血流动力学的决定性因素。

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