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目的探讨碎裂QRS波(fQRS)对行直接经皮冠状动脉介入治疗(PPCI)的ST段抬高心肌梗死(STEMI)患者在住院期间预后的预测价值。方法采用回顾性分析方法收集2013年1月至2014年4月在天津医科大学第二医院心脏科及河北省吴桥县人民医院住院期间诊断为ST段抬高型心肌梗死的350例患者为研究对象,收集其一般资料、实验室检查、心电图、超声心动图和冠脉造影结果,根据心电图有无碎裂QRS波分为fQRS组(180例)及无fQRS组(170例),比较两组患者住院期间心血管恶性事件(MACE)发生率。用SPSS 18.0软件进行t检验、χ2检验。结果 fQRS组心肌梗死病史比例(7.7%)、肌钙蛋白I峰值[(26.8±17.6)ng/ml]、肌酸激酶同工酶峰值[(213.4±160.9)ng/ml]均高于无fQRS组[分别为2.9%、(22.7±17.1)ng/ml、(173.71±185.7)ng/ml];左室射血分数(52.1%±8.7%)低于无fQRS组(56.4%±7.8%);侧支循环少于无fQRS组;住院期间的MACE事件发生率(19.4%)高于无fQRS组(11.0%),差异均有统计学意义(P<0.05,P<0.01)。结论 STEMI患者的fQRS对于住院期间的MACE事件有显著的预测价值,fQRS是心肌梗死(MI)急性期内有预测价值的心电指标。
Objective To investigate the prognostic value of fragmented QRS wave (fQRS) in hospitalized patients with ST-elevation myocardial infarction (STEMI) undergoing direct percutaneous coronary intervention (PPCI). Methods A retrospective analysis method was used to collect 350 patients diagnosed as ST-segment elevation myocardial infarction during the hospitalization period from January 2013 to April 2014 in the Department of Cardiology, the Second Hospital of Tianjin Medical University and Wuqiao People’s Hospital of Hebei Province. The general data, laboratory tests, electrocardiogram, echocardiography and coronary angiography were collected. According to whether the QRS wave was fragmented, the patients were divided into fQRS group (n = 180) and fQRS group (n = 170) Cardiovascular Malignancy (MACE) Incidence During Hospitalization. SPSS 18.0 software t test, χ2 test. Results The percentage of myocardial infarction in the fQRS group (7.7%), peak troponin I [(26.8 ± 17.6) ng / ml) and peak creatine kinase isoenzyme (213.4 ± 160.9 ng / ml) were higher than those without fQRS (22.7 ± 17.1) ng / ml and (173.71 ± 185.7) ng / ml, respectively), and left ventricular ejection fraction (52.1% ± 8.7% vs 56.4% ± 7.8% ; Collateral circulation less than without fQRS group; incidence of MACE during hospitalization (19.4%) was higher than without fQRS group (11.0%), the difference was statistically significant (P <0.05, P <0.01). Conclusions fQRS in STEMI patients has significant predictive value for MACE events during hospitalization. FQRS is a predictor of ECG in the acute phase of myocardial infarction (MI).