Dell'Italia L J, Starling M R, O'Rourke R A
Ann Intern Med. 1983 Nov;99(5):608-11. doi: 10.7326/0003-4819-99-5-608.
Fifty-three consecutive patients with inferior myocardial infarction were evaluated prospectively, by physical examination and right heart catheterization within 36 hours of the onset of symptoms, to determine whether physical findings can separate such patients into those with and without associated right ventricular infarction. Hemodynamic findings consistent with right ventricular infarction were defined as right atrial pressure of 10 mm Hg or greater and a right atrial: pulmonary artery wedge pressure ratio of 0.80 or greater. Eight patients (Group 1) had hemodynamic evidence of right ventricular infarction, whereas 45 patients (Group 2) did not meet these criteria. Group 1, compared with Group 2, had a lower cardiac index (1.8 +/- 0.3 versus 2.6 +/- 0.6 L/min X m2, p less than 0.001), and a lower right ventricular stroke work index (4.1 +/- 3.6 versus 7.3 +/- 3.2 g X m/m2, p less than 0.05). An elevated jugular venous pressure of 8 cm H2O or more was seen in 7 of 8 Group 1 and 14 of 45 Group 2 patients (p less than 0.01). In addition, a Kussmaul's sign, substantiated by hemodynamic findings, was seen in all 8 Group 1 and in no Group 2 patients (p less than 0.001). The absence of both an elevated jugular venous pressure and a Kussmaul's sign in patients with inferior myocardial infarction makes the presence of a hemodynamically significant right ventricular infarction highly unlikely.
对53例连续性下壁心肌梗死患者在症状发作36小时内进行了前瞻性评估，通过体格检查和右心导管检查，以确定体格检查结果能否将这些患者分为合并或未合并右心室梗死的两组。符合右心室梗死的血流动力学表现定义为右心房压力≥10mmHg且右心房压力与肺动脉楔压之比≥0.80。8例患者（第1组）有右心室梗死的血流动力学证据，而45例患者（第2组）不符合这些标准。与第2组相比，第1组的心脏指数较低（1.8±0.3对2.6±0.6L/min·m²，p<0.001），右心室每搏作功指数也较低（4.1±3.6对7.3±3.2g·m/m²，p<0.05）。第1组8例患者中有7例、第2组45例患者中有14例出现颈静脉压升高≥8cmH₂O（p<0.01）。此外，经血流动力学检查证实的库斯莫尔征在第1组所有8例患者中均有出现，而第2组患者中均未出现（p<0.001）。下壁心肌梗死患者若既无颈静脉压升高也无库斯莫尔征，则极不可能存在血流动力学显著的右心室梗死。
