De Hert S G, Moens M M, Vermeyen K M, Hageman M P
Department of Anesthesia, University Hospital Antwerp, Belgium.
J Cardiothorac Vasc Anesth. 1993 Dec;7(6):659-67. doi: 10.1016/1053-0770(93)90049-q.
This study evaluated the benefit of additional electrocardiographic monitoring of the right precordial lead V4R for detection of ST segment changes during elective coronary artery bypass surgery in 210 patients. ST segment analysis was performed for leads I, II, CB5, and V4R. ST segment changes were noted in 60 patients. Of these, 32 had combined left-sided and right-sided coronary artery disease (group A), and 28 had only left-sided coronary artery disease on coronary angiography (group B). Lead sensitivity was estimated assuming that all ST segment changes were true positive responses. Sensitivity using a single lead was greatest for lead CB5 in the two groups (76% in group A and 78% in group B). Sensitivity for lead I was low in both groups (34% in group A and 26% in group B). Sensitivity for lead II was 63% in group A and 52% in group B, and sensitivity for lead V4R was 71% in group A but only 37% in group B. Combination of leads V4R and CB5 increased sensitivity to 98% in group A. In group B, this lead combination had a sensitivity of 93%, but lead combinations I-CB5-V4R and II-CB5-V4R were more sensitive (97% and 100%, respectively). The monitoring of lead V4R allowed detection of 20% of ST segment changes in group A that would have passed undetected if only leads I, II, and CB5 were monitored. These results demonstrate the value of additional electrocardiographic monitoring of the right precordial lead V4R during coronary artery bypass grafting in patients with right-sided coronary artery disease.
本研究评估了在210例择期冠状动脉搭桥手术患者中，额外进行右胸前导联V4R心电图监测以检测ST段变化的益处。对导联I、II、CB5和V4R进行ST段分析。60例患者出现ST段变化。其中，32例患有左、右冠状动脉合并疾病（A组），28例在冠状动脉造影中仅患有左冠状动脉疾病（B组）。假设所有ST段变化均为真阳性反应，估算导联敏感性。两组中，单导联敏感性最高的是导联CB5（A组为76%，B组为78%）。两组中导联I的敏感性均较低（A组为34%，B组为26%）。导联II在A组的敏感性为63%，在B组为52%，导联V4R在A组的敏感性为71%，但在B组仅为37%。导联V4R与CB5联合可使A组的敏感性提高到98%。在B组中，这种导联组合的敏感性为93%，但导联I-CB5-V4R和II-CB5-V4R更敏感（分别为97%和100%）。对导联V4R的监测可检测出A组中20%的ST段变化，若仅监测导联I、II和CB5，这些变化将未被发现。这些结果证明了在患有右冠状动脉疾病的患者进行冠状动脉搭桥手术期间，额外进行右胸前导联V4R心电图监测的价值。
