论文部分内容阅读
目的:分析QRS波积分对ST段抬高型急性心肌梗死(STEMI)患者近期心功能不全及心源性猝死(SCD)的预测作用。方法:收集在心内科住院的STEMI患者80例,无束支传导阻滞及起搏器置入,随访6个月,记录其入院时及出院前标准12导联心电图,用Selvester积分系统方法分为QRS积分≤3组和QRS积分>3组,比较两组临床特点,生化检查:血BNP,心脏超声检查,6个月内患者因心功能不全住院次数及SCD发生率,应用统计学软件进行分析。结果:QRS积分≤3组共52例,平均年龄(61.4±13.1)岁;QRS积分>3组共28例,平均年龄(71.6±11.4)岁,两组比较差异有统计学意义(P<0.05);与QRS积分≤3组比较,QRS积分>3组患者心率显著增快[(78.96±15.06)次/min∶(72.0±12.5)次/min,P<0.05],非下壁心肌梗死组显著增多(72.7%∶60.0%,P<0.05);QRS积分≤3组在半年年内未发生SCD,QRS积分>3组在半年内发生SCD/心力衰竭(心衰)者10例,占该组的35.7%,两组之间差异有统计学意义(P<0.05),给予多变量分析后QRS波积分是急性心肌梗死患者心衰/SCD的独立危险因素(OR1.52,95%CI:1.03~2.10,P<0.01)。结论:QRS积分是STEMI患者近期预后(心功能不全及SCD)独立的预测因子。
OBJECTIVE: To analyze the predictive value of QRS wave on the recent cardiac insufficiency and sudden cardiac death (SCD) in patients with STEMI. Methods: Eighty STEMI patients were enrolled in the Department of Cardiology. Without bundle branch block and pacemaker implantation, they were followed up for 6 months. The standard 12-lead electrocardiogram was recorded at admission and before discharge. The Selvester integration system QRS score ≤3 group and QRS score> 3 groups. The clinical features, biochemical examination: blood BNP, echocardiography, frequency of hospitalization due to cardiac insufficiency within 6 months, and incidence of SCD were analyzed with statistical software . Results: There were 52 cases with QRS score≤3, mean age (61.4 ± 13.1) years old; QRS score> 3 groups with 28 cases (average 71.6 ± 11.4 years), the difference was statistically significant (P <0.05 ). Compared with QRS score ≤3, QRS score> 3 significantly increased heart rate (78.96 ± 15.06) times /min:(72.0 ± 12.5) times / min, P <0.05) and non-inferior myocardial infarction (72.7%, 60.0%, P <0.05); QRS score ≤3 group had no SCD within half a year, QRS score> 3 group had SCD / heart failure (P <0.05). The QRS wave score after multivariate analysis was an independent risk factor for CHF / SCD in patients with acute myocardial infarction (OR 1.52, 95% CI: 1.03 ~ 2.10, P <0.01). Conclusions: QRS score is an independent predictor of recent outcome (cardiac insufficiency and SCD) in patients with STEMI.