QRS波群形态对急性心肌梗死患者心功能和预后的影响  

Effects of admission QRS complex on ventricular function and prognosis in patients with acute myocardial infarction

作　　者：王荣英[1] 田英平[1] 张晓雷[1] 李旭蕊[1] 石汉文[1] 郭宪立[1] 

机构地区：[1]河北医科大学第二医院急诊科,河北石家庄050000

出　　处：《中国老年学杂志》2010年第19期2726-2728,共3页Chinese Journal of Gerontology

基　　金：河北省科技厅科研基金资助项目(08206116D)

摘　　要：目的通过对急性ST段抬高心肌梗死(STEMI)患者入院时心电图QRS波群变化进行缺血分级,探讨缺血分级的临床意义。方法 223例STEMI患者根据入院时心电图QRS波群变化进行缺血分级:2级缺血组(134例):ST段抬高但QRS波终末部无改变;3级缺血组(89例):除ST段抬高外,QRS波终末部扭曲且常伴R波增高与S波消失。两组患者在发病12h内均行溶栓治疗,观察心电图ST段变化;梗死后2w行99m锝-甲氧基异丁基异腈(99mTc-MIBI)心肌灌注断层显像(SPECT)和99m锝-红细胞(99mTc-RBC)心血池显像,测定心肌梗死面积和心功能;统计2组患者住院期间并发症的发生率。结果入院时和溶栓后2h,3级缺血组ST段抬高的幅度(∑ST)均显著大于2级缺血组(P<0.01),溶栓后2h,ST段回降率显著低于2级缺血组(P<0.01);3级缺血组肌酸激酶同工酶(CK-MB)峰值显著高于2级缺血组(P<0.01),心肌梗死面积大于2级缺血组(P<0.05),左室射血分数低于2级缺血组(P<0.05);两组患者严重心律失常、心力衰竭或心源性休克、再梗死的发生率和住院病死率均无显著性差异,但3级缺血组有高于2级缺血组的趋势。结论入院时心电图呈3级缺血的急性STEMI患者溶栓后易于出现ST段回降不良,导致心肌梗死面积大,心功能和预后差,需要采取更加积极的治疗措施。Objective To investigate clinical significance of the grade of ischemia by QRS complex on the admission electrocardiogram （ECG） in patients with acute ST-segment elevation myocardial infarction （STEMI）. Methods 223 patients with acute STEMI who received thrombolytic therapy,were divided into two groups based on the enrollment electrocardiogram：grade 2 ischemia （ST elevation without terminal QRS distortion; n=134） and grade 3 ischemia （ST elevation with terminal QRS distortion; n=89）. 99mTc-MIBI SPECT was performed to detect myocardial infarction area（MIA）; 99mTc gated cardiac blood pool image was performed to measure ventricular function. The incidence rate of ST segment resolution （STR）,and complications in hospital stay were observed. Results ①Patients with grade 3 ischemia had greater ST on admission and 2 h after thrombolysis ECGs （P0.01）,the incidence rate of STR in patients with grade 3 ischemia was lower than that in patients with grade 2 ischemia （P0.01）. ② The peak creatine kinase MB fraction was higher,MIA was greater,and left ventricular eject fraction was lower in patients with grade 3 ischemia than those in patients with grade 2 ischemia （P0.01; P0.05）. ③There was no significant difference of the incidence of severe arrhythmia,heart failure,cardiogenic shock,re-infarction and mortality in hospital between the two groups （P0.05）,but there was a trend of higher incidence of complications in patients with grade 3 ischemia compared with that in patients with grade 2 ischemia. Conclusions Grade 3 ischemia on admission is associated with lower incidence of STR,worse ventricular function and prognosis in patients with STEMI after thrombolysis. These patients should require more active management to improve prognosis.

关 键 词：急性ST段抬高心肌梗死 溶栓治疗 心功能 预后 

分 类 号：R544.1[医药卫生—心血管疾病]