Pagani L, Simeone M, Franciosi G, Cao M, Loria F, Pelosi G
Servizio di Anestesia e Rianimazione II, Ospedale Maggiore della Carità-Novara, Italy.
Eur J Anaesthesiol. 1996 Sep;13(5):511-4. doi: 10.1046/j.1365-2346.1996.00990.x.
This study was designed to determine the intra-operative incidence of right-sided ventricular ischaemia and any association with left ventricular ischaemia. In 60 patients, undergoing coronary artery bypass grafting surgery, a right-sided precordial lead V5R was used. ST segment deviation of more than 1 mm in V5R was considered significant for myocardial ischaemia. Right ventricular ischaemia occurred in 14 patients (23.3%) but was not associated with left ventricular inferior wall ischaemia. In 4 patients (6.6%) presenting with right ventricular ischaemia, ischaemia of the left inferior wall also developed but in all cases was transient and disappeared by the end of surgery. No myocardial infarction was detected in the post-operative period. The present study showed that the use of a right-sided lead may improve intra-operative electrocardiographic monitoring, by revealing ischaemia in those patients in whom ECG abnormalities were not detected by conventional leads. The transient right ventricular ischaemia recorded in this study was probably related to a reduced hypothermic protection of the right ventricle during aortic cross clamping.
本研究旨在确定术中右侧心室缺血的发生率以及与左侧心室缺血的任何关联。在60例行冠状动脉旁路移植术的患者中，使用了右侧胸前导联V5R。V5R导联ST段偏移超过1mm被认为心肌缺血显著。14例患者（23.3%）发生右侧心室缺血，但与左侧心室下壁缺血无关。4例（6.6%）出现右侧心室缺血的患者同时发生了左侧下壁缺血，但所有病例均为短暂性，手术结束时消失。术后未检测到心肌梗死。本研究表明，使用右侧导联可能通过揭示常规导联未检测到心电图异常的患者的缺血情况来改善术中心电图监测。本研究记录的短暂性右侧心室缺血可能与主动脉交叉阻断期间右心室低温保护降低有关。
