心电图对陈旧性心肌梗死风险评估的价值探讨  

The discussion on the value of risk assessment about surface ECG in old myocardial infarction

作　　者：马淑英[1] 吕金兰[1] 杨文波[1] 张媛[1] 王乐信 孙熙璇[1] 

机构地区：[1]聊城市人民医院心电图室,山东省252000 [2]澳大利亚查尔斯特大学心血管病研究中心、澳大利亚及纽西兰心脏病学院

出　　处：《中国心血管病研究》2014年第6期504-507,共4页Chinese Journal of Cardiovascular Research

摘　　要：目的通过对陈旧性心肌梗死（OMI）患者碎裂QRS波（fQRS）、病理性Q波及其与室性心律失常的发生情况进行分析，探讨fQRS及病理性Q波与室性心律失常的关系，以评估心电图对陈旧性心肌梗死风险的预测价值。方法对335例确诊陈旧性心肌梗死的患者进行动态心电图检查，将OMI伴单纯fQRs波患者分为前壁组（61例）、下壁组（40例）和侧壁组（15例），并对各组间室性心律失常发生率进行比较分析；根据fQRS波时限，将OMI伴fQRs波患者分为fQRS≥110ms组（36例）、fQRS〈110ms（156例），并对两组间室性心律失常发生率进行对比分析；根据病理性Q波QRS波群时限，将OMI伴病理性Q波患者分为QRS≥110ms组（21例）、QRS〈110ms（75例），并对两组间室性心律失常发生率进行对比分析。结果OMI伴单纯fQRs波患者不同部位间室性心律失常发生率无明显差异（P均〉0．05）；OMI伴fQRs波患者fQRS≥110ms组室性心动过速发生率明显高于fQRS〈110ms组（P=0．026）；OMI伴病理性Q波患者QRS≥110ms组成对室性期前收缩（P=0．045）发生率明显高于QRS〈110ms组。结论OMI患者fQRs时限越长，发生室性心动过速的风险越高；OMI患者QRS波时限越长，发生成对室性期前收缩的风险越高，QRS时限是OMI患者室性心律失常预警的心电图指标。Objective By analyzing the relationship among QRS fragmentation wave（fQRS）, pathological Q waves and ventricular arrhythmias in patients with old myocardial infarction （OMI）, the study is to assess the predictive value of electrocardiogram for risk of old myocardial infarction. Methods The Hoher was obtained from all 335 patients, and the ventricular arrhythmias results were comparatively analyzed. The OMI with fQRS waves were divided into anterior group（61 cases）, inferior wall group（40 cases） and the sidewall group（15 eases）. Ac- cording to fQRS wave duration, OMI patients with fQRS were divided into fQRS≥110 ms group （36 cases）, fQRS〈 110 ms group （156 cases ）, and the incidence of ventricular arrhythmias between the two groups were ana- lyzed. According to QRS wave duration of pathologic Q waves, OMI patients with pathologic Q waves were divided into QRS ≥ 110 ms group（21 cases）, QRS〈 110 ms group（75 cases）, and the incidence of ventricular arrhythmias between the two groups were analyzed. Results The incidence of ventricular arrhythmias was not significantly dif- ferent between different parts of OMI patients with simple fQRS wave （P〉0.05）. The fQRS duration in OMI pa- tients with fQRS was longer, the risk of ventricular tachyeardia was higher （P=0.026）. The QRS wave duration in OMI patients with pathalogical Q wave was longer, the risk of pair ventricular contractions was higher （P=0.045）.Conclusion The longer fQRS time of OMI patients with fQRS, the higher the risk of ventricular tachycardia, and the longer QRS wave duration of OMI with rational Q wave patients, the higher the risk of pair ventricular prema- ture contractions occurred, so QRS duration is a prediction index of OMI. QRS duration in patients with ventricular arrhythmias are early warning indicators of the ECG.

关 键 词：陈旧性心肌梗死 碎裂QRS波 病理性Q波 室性心律失常 QRS时限 

分 类 号：R542.22[医药卫生—心血管疾病]