【摘要】 目的 :探讨梗死性室性异位心搏 (IVEB)的临床、心电图特点及其在急性心肌梗死 (AMI)早期诊断和定位中的价值。方法 :对 17例在AMI时出现IVEB的患者与同期住院的 5 7例无IVEB的AMI患者进行对照分析 ,并比较IVEB与同期窦性心律和充分进展期窦性心律的QRS ST T波群的形态学改变。结果 :①IVEB的QRS形态常呈右束支阻滞形态 ;除Q波型AMI外 ,非Q波型AMI亦可发生IVEB。②单因素分析显示IVEB常发生于AMI的早期 (<4h) ,以下壁伴或不伴后壁及 (或 )右室AMI好发 (P <0 .0 5～ 0 .0 0 1) ;多因素非条件logistic回归分析显示下 (后 )壁AMI、大面积MI、心功能差及梗死早期 (<4h)者易发生IVEB(χ2 =3.87～12 .0 5 ,P <0 .0 5 )。③与同期窦性心律比较 ,IVEBQ波出现及ST段抬高提早 ,且更具有AMI的特征。④IVEB可发生于心肌酶学升高及窦性心律典型AMI图型出现之前 ,其对AMI的早期诊断及定位 ,优于同期窦性心律。结论 :IVEB并非罕见 ,它有助于AMI的早期诊断及定位更多还原

【Abstract】 Objective:To investigate the clinical and electrocardiograph character of infarctional ventricular ectopic beat (IVEB) and its value in early diagnosis and location for acute myocardial infarction(AMI). Methods:17 AMI patients with IVEB and 57 AMI patients without IVEB were analyzed.A comparison was made between IVEB and sinus rhythm of the same period and fully developed phase in morphlogical changes of QRS complex 、ST segment and T wave.Results:① IVEB QRS complex often revealed the right bundle branch block morphology (RBBBM), beside Q waves AMI, no Q waves AMI had IVEB.②Single factor analysis found IVEB often appeared in early AMI(<4h).They were more frequent in inferoposterior with/without right ventricular involvement than those anterior or anteroseptal myocarction .Multi factors no condition logistic regress analysis revealed IVEB had positive correlation with the early AMI、AMI size、killip heart function degree、inferoposterior with/without right ventricular involvement(X 2=3.87～12.05,p<0.05).③The Q wave of IVEB was winder and ST segment elevation was higher than that of the same period sinus rhythm.④The infarctional morphological changes of venteicular ectopic beats could be found before same period sinus rhythm and myocardial enzyme rise.Conclusion: IVEB is not rare.They are always useful in the early diagnosis and location of AMI.更多还原