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早期复极(early repolarization,ER)与特发性室性心动过速/心室颤动、心源性猝死密切相关,严重时可引起病人死亡。早期复极图形(early repolarization pattern,ERP)仍是目前心血管病领域研究的重要课题,已有研究探讨ERP与严重室性心律失常、心源性猝死的发生机制,尤其是ERP预测心源性猝死、离子流机制等方面[1]。有研究[2]认为,ER联合ST段抬高程度和J波振幅等参数对预测高危心源性猝死病人具有重要的价值。既往观点[3-4]认为,将ER阐述为QRS波终末切迹或顿挫,且与ST段、J点抬高程度及形态等方面以初步判断ER的良恶性。但目前有关QRS波群对急性前壁心肌梗死病人心源性猝死风险预测价值的研究报道较为少见。为此,本研究将本院收治的98例急性前壁心肌梗死病人作为研究对象,研究病人心电图(electrocardiogram,ECG)的QRS波群的特点、表现,旨在探讨QRS波群对急性前壁心肌梗死病人心源性猝死风险的预测价值,进而为临床应用提供一定的依据。
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2组病人性别、年龄、吸烟史、基础性疾病(糖尿病、高血脂症、高血压史)、冠状动脉开通时间及LVEF等资料比较差异均无统计学意义(P>0.05);但阳性组TG、血钾水平较阴性组明显升高(P < 0.01),心室颤动、室性心动过速和死亡率较阴性组亦明显升高(P < 0.01)(见表 1)。
项目 阴性组(n=49) 阳性组(n=49) χ2 P 男/女 31/18 27/22 0.68 >0.05 年龄/岁 57.97±5.35 59.01±4.27 1.06* >0.05 BMI/(kg/m2) 24.61±2.99 25.57±3.12 1.56* >0.05 吸烟史 29(59.18) 32(65.31) 0.39 >0.05 糖尿病史 12(24.49) 15(30.61) 0.46 >0.05 高血压史 26(53.06) 24(48.98) 0.16 >0.05 高血脂症史 11(22.45) 10(20.41) 0.06 >0.05 LVEF/% 46.24±7.64 48.79±6.90 1.73* >0.05 TG/(mg/dL) 1.31±0.91 1.85±0.47 3.69* < 0.01 血钾/(mmol/L) 4.05±0.52 4.78±1.36 3.51* < 0.01 冠状动脉病变数 单支 25(51.02) 23(46.94) 0.16 >0.05 多支 24(48.98) 26(53.06) 冠状动脉开通时间/h 6.95±2.01 7.79±2.32 1.92* >0.05 室性心动过速 1(2.04) 17(34.69) 17.42 < 0.01 心室颤动 1(2.04) 18(36.73) 18.67 < 0.01 死亡 0 16(32.65) 19.12 < 0.01 *示t值 表 1 临床基本资料的比较(x±s)
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阳性组QRS时限较阴性组明显延长(P < 0.01),HR较阴性组明显减慢(P < 0.01),QTc间期较阴性组缩短(P < 0.01);但2组病人QT间期和PR间期差异均无统计学意义(P>0.05)(见表 2)。
分组 n QRS时限/min HR/(次/分) QTc间期/ms QT间期/ms PR间期/ms 阴性组 49 89.07±7.93 77.98±6.90 459.04±31.24 401.45±49.79 161.90±25.16 阳性组 49 97.96±7.23 68.05±10.32 424.05±39.68 405.02±51.22 160.05±26.52 t — 5.80 5.60* 4.85 0.35 0.35 P — < 0.01 < 0.01 < 0.01 >0.05 >0.05 *示t′值 表 2 2组病人ECG参数的比较(x±s)
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阳性组病人ERP导联分布多处于下壁(27例,55.10%)、下壁+胸前导联(16例,32.65%),而少数为侧壁+胸前导联(4例)、侧壁(2例);ERP以切迹(24例,48.98%)为主要表现,其次是顿挫型(20例,40.81%),而少数为顿挫和切迹混合型(2例)和J点抬高型(其中抬高>0.2 mV者1例,抬高0.1~0.2 mV者2例);ST段多为水平型抬高(46例,93.88%),少数为上斜型抬高(3例)。
QRS波群对急性前壁心肌梗死病人心源性猝死风险的预测价值分析
Value of the QRS wave in the prediction of the risk of sudden cardiac death in patients with acute anterior wall myocardial infarction
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摘要:
目的分析QRS波群对急性前壁心肌梗死病人心源性猝死风险的预测价值。 方法将98例急性前壁心肌梗死病人作为研究对象,分为早期复极(ER)阴性组和阳性组,各49例。分析病人ER图形特点、形态等,比较2组心室颤动、室性心动过速和死亡等发生率。 结果阳性组QRS时限[(97.96±7.23)min]较阴性组[(89.07±7.93)min]明显延长(P < 0.01),心率[(68.05±10.32)次/分]较阴性组[(77.98±6.90)次/分]明显减慢(P < 0.01),QTc间期[(424.05±39.68)ms]较阴性组[(459.04±31.24)ms]缩短(P < 0.01);但2组病人QT间期、PR间期差异均无统计学意义(P>0.05)。阳性组病人ER图形多处于下壁、下壁加胸前导联,以切迹为主要表现,且ST段多为水平型抬高。阳性组三酰甘油、血钾水平较阴性组明显升高(P < 0.01),心室颤动、室性心动过速和死亡率亦明显高于阴性组(P < 0.01)。 结论相比无ER的急性前壁心肌梗死病人,伴有ER者心电图QRS时限延长、QTc间期缩短、心率减缓,心室颤动、室性心动过速的发生率明显升高,且发生死亡的风险明显提高。 Abstract:ObjectiveTo analyze the predictive value of QRS wave in the risk of sudden cardiac death in patients with acute anterior wall myocardial infarction. MethodsNinety-eight patients with acute anterior myocardial infarction were divided into the early repolarization(ER) negative group and positive group(49 cases each group).The characteristics and morphology of the early repolarization pattern(ERP) in two groups were analyzed, and the incidence rates of ventricular fibrillation, ventricular tachycardia and death between two groups were compared. ResultsThe time limit of QRS in positive group[(97.96±7.23)min] was significantly longer than that in negative group[(89.07±7.93)min](P < 0.01), the heart rate in positive group[(68.05±10.32) times/min] was significantly slower than that in negative group[(77.98±6.90) times/min](P < 0.01), and the OTc interval time in positive group[(424.05±39.68)ms] was significantly shorter than that in negative group[(459.04±31.24)ms](P < 0.01).The differences of the QT and PR interval time between two groups were not statistically significant(P>0.05).In the positive group, the ERP mostly located in the lower wall, lower wall and precordial lead; the main manifestation of which located the incisor; and the ST segment was mostly horizontal elevation.The levels of triglyceride and potassium in positive group were significantly higher than those in negative group(P < 0.01), and the incidence rates of ventricular fibrillation, ventricular tachycardia and death in positive group were significantly higher than those in negative group(P < 0.01). ConclusionsCompared with the acute anterior myocardial infarction patients without ER, the QRS duration of electrocardiogram prolongs, the QTc interval shortens, the heart rate decreases, the incidence rates of ventricular fibrillation and ventricular tachycardia increase significantly, and the risk of death increases significantly in the patients with ER. -
Key words:
- myocardial infarction /
- early repolarization /
- QRS wave /
- sudden cardiac death
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表 1 临床基本资料的比较(x±s)
项目 阴性组(n=49) 阳性组(n=49) χ2 P 男/女 31/18 27/22 0.68 >0.05 年龄/岁 57.97±5.35 59.01±4.27 1.06* >0.05 BMI/(kg/m2) 24.61±2.99 25.57±3.12 1.56* >0.05 吸烟史 29(59.18) 32(65.31) 0.39 >0.05 糖尿病史 12(24.49) 15(30.61) 0.46 >0.05 高血压史 26(53.06) 24(48.98) 0.16 >0.05 高血脂症史 11(22.45) 10(20.41) 0.06 >0.05 LVEF/% 46.24±7.64 48.79±6.90 1.73* >0.05 TG/(mg/dL) 1.31±0.91 1.85±0.47 3.69* < 0.01 血钾/(mmol/L) 4.05±0.52 4.78±1.36 3.51* < 0.01 冠状动脉病变数 单支 25(51.02) 23(46.94) 0.16 >0.05 多支 24(48.98) 26(53.06) 冠状动脉开通时间/h 6.95±2.01 7.79±2.32 1.92* >0.05 室性心动过速 1(2.04) 17(34.69) 17.42 < 0.01 心室颤动 1(2.04) 18(36.73) 18.67 < 0.01 死亡 0 16(32.65) 19.12 < 0.01 *示t值 表 2 2组病人ECG参数的比较(x±s)
分组 n QRS时限/min HR/(次/分) QTc间期/ms QT间期/ms PR间期/ms 阴性组 49 89.07±7.93 77.98±6.90 459.04±31.24 401.45±49.79 161.90±25.16 阳性组 49 97.96±7.23 68.05±10.32 424.05±39.68 405.02±51.22 160.05±26.52 t — 5.80 5.60* 4.85 0.35 0.35 P — < 0.01 < 0.01 < 0.01 >0.05 >0.05 *示t′值 -
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