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心电学习笔记(230)ST段斜直型抬高

  • 2026-02-05 14:28:02
心电学习笔记(230)ST段斜直型抬高
早上在胸痛中心遇见一份图，长这样：
男，45+岁，因胸痛胸闷半小时就诊。急诊科完善心电图如上。
从图中可以看出，该图II III aVF导联ST段抬高，I导联ST段位于基线，但aVLST段下斜型压低。同样，V7-V9导联ST段也轻度抬高，结合患者有胸闷胸痛症状，高度怀疑急性下壁+后壁ST段抬高型心肌梗死。
除了要识别到AMI之外，今天主要是想分享一下，什么叫做ST段斜直型抬高。说实在话，念书的时候，老师总是说，急性心梗时，ST段呈弓背向上型抬高，直到自己从事这个行业并且看书了之后，才发现，原来AMI的ST段抬高是多种类型的，其中一种就叫做斜直型。
斜直型ST段抬高：正常凹面向上的ST段变直，与T波正常连接角消失，导致两者不易区别且间接使T波变宽，然后，ST段直线向上升高并倾斜地与高耸T宽大的T波相连，ST段呈不对称性，见于超急性期心梗、变异性心绞痛及迷走神经张力过高者。
所以，AMI的ST段抬高有很多种类型，而ST段呈斜直型抬高，也不仅仅见于AMI。
今天这个患者，胸痛胸闷时间半小时就诊，完善心损三项肌钙蛋白I、肌红蛋白及CK-MB均处于正常范围内，心电图可见下壁+后壁导联ST段呈斜直型抬高+aVL导联ST段压低（心电图有急性缺血定位改变）→符合超急性期下壁+后壁心肌梗死。
造影提示回旋支中段80%狭窄伴血栓，后于回旋支植入支架一枚。
有同行老师可以会有疑问，遇到ST段斜直型抬高，该如何鉴别AMI还是迷走神经张力过高——也就是通常所说的早期复极化？其实这个不是很难的，症状+动态改变+导联改变是否有罪犯血管定位，就可以鉴别个七八成。而且，通常来说，AMI的斜直型ST段抬高会伴有R波丢失，ST段特别“直”，和正常变异还是不一样的。这个多看图培养图感就慢慢悟了。
以上仅代表个人目前的意见，欢迎各位老师留言纠错、赐教、讨论。
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  137. /yingpanguazai/ssd/ssd1/www/no.67808.cn/vendor/topthink/think-template/src/template/driver/File.php ( 2.41 KB )
  138. /yingpanguazai/ssd/ssd1/www/no.67808.cn/vendor/topthink/think-template/src/template/contract/DriverInterface.php ( 0.86 KB )
  139. /yingpanguazai/ssd/ssd1/www/no.67808.cn/runtime/temp/6df755f970a38e704c5414acbc6e8bcd.php ( 12.06 KB )
  140. /yingpanguazai/ssd/ssd1/www/no.67808.cn/vendor/topthink/think-trace/src/Html.php ( 4.42 KB )
  1. CONNECT:[ UseTime:0.000913s ] mysql:host=127.0.0.1;port=3306;dbname=no_67808;charset=utf8mb4
  2. SHOW FULL COLUMNS FROM `fenlei` [ RunTime:0.001506s ]
  3. SELECT * FROM `fenlei` WHERE `fid` = 0 [ RunTime:0.003454s ]
  4. SELECT * FROM `fenlei` WHERE `fid` = 63 [ RunTime:0.005134s ]
  5. SHOW FULL COLUMNS FROM `set` [ RunTime:0.001437s ]
  6. SELECT * FROM `set` [ RunTime:0.011393s ]
  7. SHOW FULL COLUMNS FROM `article` [ RunTime:0.001588s ]
  8. SELECT * FROM `article` WHERE `id` = 462986 LIMIT 1 [ RunTime:0.001102s ]
  9. UPDATE `article` SET `lasttime` = 1770652061 WHERE `id` = 462986 [ RunTime:0.055263s ]
  10. SELECT * FROM `fenlei` WHERE `id` = 65 LIMIT 1 [ RunTime:0.009846s ]
  11. SELECT * FROM `article` WHERE `id` < 462986 ORDER BY `id` DESC LIMIT 1 [ RunTime:0.001202s ]
  12. SELECT * FROM `article` WHERE `id` > 462986 ORDER BY `id` ASC LIMIT 1 [ RunTime:0.003207s ]
  13. SELECT * FROM `article` WHERE `id` < 462986 ORDER BY `id` DESC LIMIT 10 [ RunTime:0.001034s ]
  14. SELECT * FROM `article` WHERE `id` < 462986 ORDER BY `id` DESC LIMIT 10,10 [ RunTime:0.000569s ]
  15. SELECT * FROM `article` WHERE `id` < 462986 ORDER BY `id` DESC LIMIT 20,10 [ RunTime:0.002642s ]
0.257807s