经皮冠状动脉介入术对急性心肌梗死碎裂QRS波的影响及预后分析  

Effect of PCI on fQRS Complex in Acute Myocardial Infarction Patients

作　　者：李国草[1] 刘艳军[1] 夏云龙[1] 高连君[1] 张树龙[1] 杨延宗[1] 董颖雪[1] 尹晓盟[1] 常栋[1] 

机构地区：[1]大连医科大学附属第一医院心内科,辽宁省大连市116011

出　　处：《中国全科医学》2014年第18期2083-2086,共4页Chinese General Practice

摘　　要：目的探讨经皮冠状动脉介入术(PCI)对急性心肌梗死(AMI)患者碎裂QRS波(fQRS)的影响及预后情况。方法选择2010年7月—2011年6月我院收治并确诊的AMI患者137例,其中男109例,女28例;平均年龄(60.5±12.5)岁。按病情不同将患者分为急诊PCI组31例、择期PCI组61例、未行PCI(拒绝或无法行PCI治疗)组45例,于术前、术后当天、术后1周、术后2周及随访6个月时分别行常规心电图检查,观察fQRS的发生率;同时根据体表心电图有无fQRS将其分成两组〔fQRS组(70例)和无fQRS组(67例)〕,比较两组室性心律失常的发生率。结果急诊PCI组、择期PCI组、未行PCI组患者的年龄、性别及高血压、糖尿病、陈旧性心肌梗死、脑梗死、心房纤颤的患病率比较,差异无统计学意义(P>0.05)。3组患者左心室射血分数(LVEF)和室壁节段性运动异常率比较,差异无统计学意义(P>0.05)。137例患者中急诊PCI组、择期PCI组及未行PCI组患者术前心电图梗死部位对应导联可见fQRS者分别为14例(45.2%)、35例(57.4%)、21例(46.7%);术前、术后当天、术后1周3组心电图fQRS发生率比较,差异无统计学意义(P>0.05);而在术后2周和随访6个月时3组fQRS发生率比较,差异有统计学意义(P<0.05);且术后2周急诊PCI组与择期PCI组患者心电图fQRS发生率较未行PCI组均降低(P<0.01),随访6个月时急诊PCI组心电图fQRS发生率较择期PCI组和未行PCI组降低(P<0.01)。3组患者住院期间室性心律失常发生率比较,差异有统计学意义(P<0.05);而住院期间病死率比较,差异无统计学意义(P>0.05)。心电图有fQRS组室性心律失常发生率高于无fQRS组〔8.6%(6/70)与0%(0/67),P=0.028〕。结论 AMI后fQRS可能与室性心律失常的发生有关,早期开通冠状动脉血管可以降低心电图fQRS及室性心律失常的发生率,为临床治疗提供有益参考。Objective To research the effects of percutaneous coronary intervention （ PCI ） on fragmented QRS （fQRS）complex in acute myocardial infarction（AMI）patients and their prognosis. Methods A total of 137 AMI patients〔109 males,28 females,meanly aged（60. 5 ±12. 5） years〕admitted to this hospital from July 2010 to June 2011 were divided into groups A（given emergency PCI,n=31）,B（given PCI in a good time,n=61）,C（not given PCI,n=45）. Conventional ECG was conducted before PCI,on that day of PCI,in weeks 1,2,months 6 after PCI,and the changes of incidence of fQRS were observed. The patients were divided,according to existence of fQRS in surface ECG,into groups fQRS（n=70）, non-fQRS（n=67）and the incidences of ventricular arrhythmia was compared between 2 groups. Results There was no significant difference in age,sex,incidences of hypertension,diabetes,old myocardial infarction,brain infarction,atrial fibrillation in groups A,B,C（P〉0. 05）. There was no difference in left ventricular ejection fraction（LVEF）,ventricular regional wall motion abnormality rate in groups A,B,C（P〉0. 05）. The fQRS complex was seen in corresponding leads of AMI sites of ECG in 14 of group A（45. 2%）,35 of group B（57. 4%）,21 of group C（46. 7%）before PCI,and there was no difference in fQRS incidence before PCI,on that day of PCI,in week 1 after PCI in 3 groups（P〉0. 05）,but there was in weeks 2, months 6 after PCI（P〈0. 05）. The incidence of fQRS was lower in groups A,B than in group C in weeks 2（P〈0. 01）, lower in group A than in groups B,C in months 6（P〈0. 01）. There was difference in incidence of ventricular arrhythmia in groups A,B,C during hospitalization（P〈0. 05）,but there was not in hospital fatality rate（P〉0. 05）. The incidence of ventricular arrhythmia was higher in group fQRS than in group non -fQRS〔8. 6%（ 6/70 ） vs. 0%（ 0/67 ）, P =0. 028〕. Conclusion Post-AMI fQRS may be related to incidence of ventricular arrhythmia. Early opening

关 键 词：心肌梗死 血管成形术 经腔 经皮冠状动脉 心律失常 心性 碎裂QRS波 

分 类 号：R541.7[医药卫生—心血管疾病]