不同部位陈旧性心肌梗死心电图特征及其与室性心律失常的相关性  

Electrocardiographic characteristics and its relationship with ventricular arrhythmia in patients with old myocardial infarction

作　　者：王英丽[1] 吕金兰[2] 马淑英[2] 马龙乐[1] 杨文波[1] 张媛[2] 梁拓[3] 王乐信 

机构地区：[1]山东省聊城市人民医院心内科,252000 [2]山东省聊城市人民医院心电图室,252000 [3]中国医学科学院阜外心血管病医院心力衰竭中心 [4]澳大利亚查尔斯特大学心血管病研究中心

出　　处：《中华心律失常学杂志》2014年第5期368-371,共4页Chinese Journal of Cardiac Arrhythmias

基　　金：山东省医药卫生科技发展计划项目（2009HZ015）

摘　　要：目的 探讨不同部位陈旧性心肌梗死（old myocardial infarction,OMI）心电图QRS波特征和碎裂QRS波（fragmented QRS complex,fQRS）的发生率及其时限与室性心律失常的关系.方法 选择2009年4月至2012年4月在山东省聊城市人民医院确诊为心肌梗死的患者335例进行心电图检查,根据QRS波形态分为病理性Q波组（96例）、fQRS波组（158例）、两者均有组（42例）和两者均无组（123例）;根据OMI的不同部位分为前壁组（61例）、下壁组（40例）和侧壁组（15例）;按照fQRS时限分为fQRS时限≥110 ms组（23例）和fQRS时限＜110 ms组（93例）.对各组数据进行统计学分析.对所有患者进行24h动态心电图检查,统计各组患者室性心律失常的发生情况并进行分析.结果 ①335例OMI患者心电图分析：fQRS波发生率明显高于病理性Q波的发生率（P＜0.01）,不同部位OMI患者fQRS波的发生率之间差异无统计学意义（P＞0.05）;②fQRS波组不同部位OMI（前壁、下壁、侧壁）患者室性心律失常的发生率差异无统计学意义（P＞0.05）;③fQRS时限≥110 ms组室性心律失常发生率高于fQRS时限＜110 ms组.结论 OMI患者心电图fQRS波发生率高于病理性Q波;不同部位OMI心电图fQRS波发生率及其与室性心律失常关系差异无统计学意义;fQRS时限延长可致室性心律失常的发生率增加.提示fQRS波可提高OMI的诊断率,对OMI室性心律失常及其心脏事件的发生具有预警作用.Objective To investigate the electrocardiogram （ECG） features and the relationship between the incidence of the fragmented QRS complex（fQRS）with its duration and ventricular arrhythmia in patients with old myocardial infarction（OMI）.Methods （1）Three hundreds and thirty-five patients with OMI were enrolled.According to the morphologies of QRS wave,patients were divided into four groups-pathological Q wave group （96 patients）,fQRS group （158 patients）,pathological Q wave plus fQRS group （42 patients）,and without patological Q wave and fQRS group （123 patients）.According to the site of myocardial infarction,patients were divided into three groups-anterior wall group （61 patients）,inferior wall group （40 patients）,and lateral wall group （15 patients）; according to fQRS duration,they were divided into two groups-fQRS duration ≥ 110 ms group and fQRS duration〈 110 ms group.The data of each group was collected and analyzed.（2） Each patient underwent 24 h dynamic ECG examination to evaluate ventricular arrhythmia.Results （1） Based on the ECG in 335 patients with OMI,the frequency of fQRS was higher than that of pathological Q wave （P〈0.01）.However,the frequency of fQRS in different OMI had no statistic difference （P〉0.05）.（2） In fQRS group,the incidence of ventricular arrhythmia in different OMI had no statistic difference （P〉0.05）.（3） The incidence of ventricular arrhythmia in the fQRS duration ≥ 110 ms group was higher than that in patients with fQRS duration〈110 ms.Conclusion In patients with OMI,the incidence of fQRS is higher than that of pathological Q wave.However,the frequency of fQRS complexes and that of ventricular arrhythmia in different OMI have no statistic difference.The prolonged QRS duration may increase the occurrence of ventricular arrhythmia.The evaluation of fQRS may be useful in the diagnosis of OMI,and it could be helpful in predicting occurrence of ventricular arrhythmia.

关 键 词：陈旧性心肌梗死 病理性Q波 碎裂QRS波 室性心律失常 

分 类 号：R541.7[医药卫生—心血管疾病]